Provider Demographics
NPI:1619335940
Name:HOLSAPPLE, RICHARD LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LYNN
Last Name:HOLSAPPLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 27TH CT SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1359
Mailing Address - Country:US
Mailing Address - Phone:503-383-3389
Mailing Address - Fax:503-383-3412
Practice Address - Street 1:4070 27TH CT SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1359
Practice Address - Country:US
Practice Address - Phone:503-383-3389
Practice Address - Fax:503-383-3412
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist