Provider Demographics
NPI:1831271964
Name:HOLLOMAN, LISA CAROL (PHARMD, BCPP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CAROL
Last Name:HOLLOMAN
Suffix:
Gender:F
Credentials:PHARMD, BCPP
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:CAROL
Other - Last Name:HOLLOMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9009 LLOYD PL
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5504
Mailing Address - Country:US
Mailing Address - Phone:310-859-1288
Mailing Address - Fax:
Practice Address - Street 1:11370 WILSHIRE BOULEVARD
Practice Address - Street 2:BUILDING 206 ROOM 230
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4801
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4962021835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric