Provider Demographics
NPI:1558581900
Name:HOLMSTROM, NADINE F (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:F
Last Name:HOLMSTROM
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 1:100 RIDGELAND LOOP
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6297
Mailing Address - Country:US
Mailing Address - Phone:701-222-1022
Mailing Address - Fax:701-663-1880
Practice Address - Street 1:511 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3120
Practice Address - Country:US
Practice Address - Phone:701-663-5188
Practice Address - Fax:701-663-1880
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist