Provider Demographics
NPI:1538625330
Name:HOLLOWAY, JAMES NELSON (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:NELSON
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:NELSON
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:14706 HANNEBAUER LN
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5633
Mailing Address - Country:US
Mailing Address - Phone:586-566-8159
Mailing Address - Fax:
Practice Address - Street 1:33201 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5924
Practice Address - Country:US
Practice Address - Phone:586-939-8171
Practice Address - Fax:586-939-8178
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist