Provider Demographics
NPI:1245839828
Name:HOLLIDAY, HELEN GENETTE
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:GENETTE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BIG HILL DR
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-8725
Mailing Address - Country:US
Mailing Address - Phone:606-464-2581
Mailing Address - Fax:606-464-2452
Practice Address - Street 1:31 BIG HILL DR
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-8725
Practice Address - Country:US
Practice Address - Phone:606-464-2581
Practice Address - Fax:606-464-2452
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT00017231183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician