Provider Demographics
NPI:1427342633
Name:AITKEN, HOLLY N
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:N
Last Name:AITKEN
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 1:3400 GREEN MOUNT CROSSING DR
Mailing Address - Street 2:T-1539
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7277
Mailing Address - Country:US
Mailing Address - Phone:618-628-3334
Mailing Address - Fax:618-628-3334
Practice Address - Street 1:3400 GREEN MOUNT CROSSING DR
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7277
Practice Address - Country:US
Practice Address - Phone:618-628-3334
Practice Address - Fax:618-628-3334
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist