Provider Demographics
NPI:1780120105
Name:HOLLAND, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HOLLAND
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 1:1116 CROSSROADS DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8277
Mailing Address - Country:US
Mailing Address - Phone:704-871-9824
Mailing Address - Fax:704-872-6462
Practice Address - Street 1:548 CC CAMP ROAD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-8704
Practice Address - Country:US
Practice Address - Phone:336-526-2640
Practice Address - Fax:336-526-2669
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist