Provider Demographics
NPI:1124561030
Name:STURGEON, HOLLIE (RPH)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:STURGEON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 THAYER LN NW APT 106
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7630
Mailing Address - Country:US
Mailing Address - Phone:603-843-7032
Mailing Address - Fax:
Practice Address - Street 1:12412 THAYER LN NW APT 106
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7630
Practice Address - Country:US
Practice Address - Phone:603-843-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60276436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist