Provider Demographics
NPI:1033826193
Name:MAERTENS HOLLAND, CONOR PATRICK (CPHT)
Entity Type:Individual
Prefix:
First Name:CONOR
Middle Name:PATRICK
Last Name:MAERTENS HOLLAND
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4413
Mailing Address - Country:US
Mailing Address - Phone:206-362-7572
Mailing Address - Fax:
Practice Address - Street 1:3018 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4413
Practice Address - Country:US
Practice Address - Phone:206-362-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61147739183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician