Provider Demographics
NPI:1972814432
Name:HATHCOCK, HOLLY HARDIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HARDIN
Last Name:HATHCOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3483
Mailing Address - Country:US
Mailing Address - Phone:731-660-3335
Mailing Address - Fax:731-660-4223
Practice Address - Street 1:3144 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3483
Practice Address - Country:US
Practice Address - Phone:731-660-3335
Practice Address - Fax:731-660-4223
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist