Provider Demographics
NPI:1992970644
Name:HOLLAND DRUG COMPANY LLC
Entity type:Organization
Organization Name:HOLLAND DRUG COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-437-0701
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2159
Mailing Address - Country:US
Mailing Address - Phone:606-437-0701
Mailing Address - Fax:
Practice Address - Street 1:5425 N MAYO TRL
Practice Address - Street 2:STE 102
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2966
Practice Address - Country:US
Practice Address - Phone:606-437-0701
Practice Address - Fax:606-437-9262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP072973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2035143OtherPK
KY7100124550Medicaid
KY7100053580Medicaid
KY7100053580Medicaid