Provider Demographics
NPI:1487727194
Name:HOLLIS, JANE DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DOUGLAS
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:D
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0967
Mailing Address - Country:US
Mailing Address - Phone:707-407-7868
Mailing Address - Fax:
Practice Address - Street 1:875 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3106
Practice Address - Country:US
Practice Address - Phone:707-923-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH45454OtherCALIFORNIA