Provider Demographics
NPI:1184764193
Name:HOLMAC, INC.
Entity type:Organization
Organization Name:HOLMAC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMELLON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-588-2888
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:MS
Mailing Address - Zip Code:39555-0010
Mailing Address - Country:US
Mailing Address - Phone:228-588-2888
Mailing Address - Fax:228-588-2890
Practice Address - Street 1:7100 HIGHWAY 614 # H
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-7395
Practice Address - Country:US
Practice Address - Phone:228-588-2888
Practice Address - Fax:228-588-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00440559332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440559Medicaid