Provider Demographics
NPI:1619567989
Name:HOLDEN, CARRIE N (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:N
Last Name:HOLDEN
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 1:4151 E COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-9679
Mailing Address - Country:US
Mailing Address - Phone:916-926-5173
Mailing Address - Fax:
Practice Address - Street 1:4151 E COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9679
Practice Address - Country:US
Practice Address - Phone:916-926-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55014183500000X
ORRPH-0015112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist