Provider Demographics
NPI:1164716460
Name:OUELLETTE, HOLLY ELAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELAINE
Last Name:OUELLETTE
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 1:22832 US HIGHWAY 281 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7430
Mailing Address - Country:US
Mailing Address - Phone:210-679-2369
Mailing Address - Fax:210-679-2379
Practice Address - Street 1:22832 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7430
Practice Address - Country:US
Practice Address - Phone:210-679-2369
Practice Address - Fax:210-679-2379
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist