Provider Demographics
NPI:1356784094
Name:HOLLINGSWORTH, WILLIAM ROBERT JR (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:HOLLINGSWORTH
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:135 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2524
Mailing Address - Country:US
Mailing Address - Phone:970-858-9508
Mailing Address - Fax:970-858-4685
Practice Address - Street 1:135 S PLUM ST
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2524
Practice Address - Country:US
Practice Address - Phone:970-858-9508
Practice Address - Fax:970-858-4685
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist