Provider Demographics
NPI:1922088723
Name:HOLLINGSWORTH, JAMES BEVAN (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BEVAN
Last Name:HOLLINGSWORTH
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 1:204 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626
Mailing Address - Country:US
Mailing Address - Phone:360-423-2220
Mailing Address - Fax:360-425-1940
Practice Address - Street 1:204 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626
Practice Address - Country:US
Practice Address - Phone:360-423-2220
Practice Address - Fax:360-425-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist