1497000640 NPI number — MRS. HOLLY MOORE WHITLOW PHARMD

Table of content: MRS. HOLLY MOORE WHITLOW PHARMD (NPI 1497000640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497000640 NPI number — MRS. HOLLY MOORE WHITLOW PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLOW
Provider First Name:
HOLLY
Provider Middle Name:
MOORE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
HOLLY
Provider Other Middle Name:
RADFORD
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497000640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 BROAD ROCK BOULEVARD
Provider Second Line Business Mailing Address:
SERVICE 119
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-675-5000
Provider Business Mailing Address Fax Number:
804-360-1082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 BROAD ROCK BOULEVARD
Provider Second Line Business Practice Location Address:
SERVICE 119
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-675-5000
Provider Business Practice Location Address Fax Number:
804-360-1082
Provider Enumeration Date:
07/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  0202211459 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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