Provider Demographics
NPI:1437757812
Name:NESTEGARD, HOLLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:NESTEGARD
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 1:10 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:TRIMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56176-1283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 GOEMANN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4659
Practice Address - Country:US
Practice Address - Phone:507-235-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist