Provider Demographics
NPI:1063770915
Name:HOLLIER, RICKEY JAMES (RPH)
Entity type:Individual
Prefix:
First Name:RICKEY
Middle Name:JAMES
Last Name:HOLLIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SANDY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5351
Mailing Address - Country:US
Mailing Address - Phone:337-981-1703
Mailing Address - Fax:
Practice Address - Street 1:2863 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5905
Practice Address - Country:US
Practice Address - Phone:337-406-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist