Provider Demographics
NPI:1912746090
Name:HOLLY PHARMACY LLC
Entity type:Organization
Organization Name:HOLLY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMANG
Authorized Official - Middle Name:VINODCHANDRA
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-467-8003
Mailing Address - Street 1:4048 GRANGE HALL RD STE D
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1193
Mailing Address - Country:US
Mailing Address - Phone:248-467-8003
Mailing Address - Fax:248-686-3484
Practice Address - Street 1:4048 GRANGE HALL RD STE D
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1193
Practice Address - Country:US
Practice Address - Phone:248-467-8003
Practice Address - Fax:248-686-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy