Provider Demographics
NPI:1205969219
Name:HOLLADAY, JOHN W (PHD, RPH)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-5245
Mailing Address - Country:US
Mailing Address - Phone:803-773-8432
Mailing Address - Fax:803-436-5533
Practice Address - Street 1:32 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-5245
Practice Address - Country:US
Practice Address - Phone:803-773-8432
Practice Address - Fax:803-436-5533
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7952OtherSC PHARM LICENSE