Provider Demographics
NPI:1891965166
Name:HOLLIE, DOUGLAS ALBERT III (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALBERT
Last Name:HOLLIE
Suffix:III
Gender:M
Credentials:RPH
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Other - Last Name:
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Mailing Address - Street 1:ONE VETERANS DRIVE
Mailing Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER (119)
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-725-2040
Mailing Address - Fax:612-727-5671
Practice Address - Street 1:ONE VETERANS DRIVE
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER (119)
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-725-2040
Practice Address - Fax:612-727-5671
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist