Provider Demographics
NPI:1184835258
Name:HOLLY, RICHARD J (DPH)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:HOLLY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2314
Mailing Address - Country:US
Mailing Address - Phone:865-693-1370
Mailing Address - Fax:
Practice Address - Street 1:9161 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1438
Practice Address - Country:US
Practice Address - Phone:865-690-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist