Provider Demographics
NPI:1700473733
Name:HOLLAND, THOMAS REEDER
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:REEDER
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SHADES CREST RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1720
Mailing Address - Country:US
Mailing Address - Phone:205-799-3288
Mailing Address - Fax:
Practice Address - Street 1:74 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-9370
Practice Address - Country:US
Practice Address - Phone:205-814-7272
Practice Address - Fax:205-753-4050
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL5570648OtherDRIVERS LICENSE