Provider Demographics
NPI:1114258001
Name:HOLLEN, STACEY LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LEIGH
Last Name:HOLLEN
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 1:4949 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7922
Mailing Address - Country:US
Mailing Address - Phone:480-592-9465
Mailing Address - Fax:
Practice Address - Street 1:5953 S WILLOW WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5119
Practice Address - Country:US
Practice Address - Phone:720-583-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.00241891835P2201X
AZS015652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care