Provider Demographics
NPI:1356641179
Name:HARTLEY, HOLLIS R (RPH)
Entity Type:Individual
Prefix:
First Name:HOLLIS
Middle Name:R
Last Name:HARTLEY
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 1:4101 NW LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-5056
Mailing Address - Country:US
Mailing Address - Phone:541-994-2500
Mailing Address - Fax:541-994-8438
Practice Address - Street 1:4101 NW LOGAN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5056
Practice Address - Country:US
Practice Address - Phone:541-994-2500
Practice Address - Fax:541-994-8438
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0009857183500000X
ORRPH-00098571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist