Provider Demographics
NPI:1942885199
Name:OBERHOLTZER, MAX HUTTON (CPHT)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:HUTTON
Last Name:OBERHOLTZER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 21ST AVE NE APT 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6635
Mailing Address - Country:US
Mailing Address - Phone:206-673-1884
Mailing Address - Fax:
Practice Address - Street 1:4750 21ST AVE NE APT 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6635
Practice Address - Country:US
Practice Address - Phone:206-673-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61037652183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician