Provider Demographics
NPI:1720355837
Name:ALVERSON, HOLLY HACKER (PHARM D)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HACKER
Last Name:ALVERSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9172 MASON ST
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2312
Mailing Address - Country:US
Mailing Address - Phone:901-486-6653
Mailing Address - Fax:
Practice Address - Street 1:6958 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7034
Practice Address - Country:US
Practice Address - Phone:662-890-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09231183500000X
TN10940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist