Provider Demographics
NPI:1518008531
Name:HOLLEY, LISANNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LISANNE
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9071 MICHAEL DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9277
Mailing Address - Country:US
Mailing Address - Phone:716-741-8623
Mailing Address - Fax:
Practice Address - Street 1:2752 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4024
Practice Address - Country:US
Practice Address - Phone:716-832-5892
Practice Address - Fax:716-832-5893
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046484-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist