Provider Demographics
NPI:1912502345
Name:HOLBROOK, SANDRA ROSE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ROSE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 RIVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7397
Mailing Address - Country:US
Mailing Address - Phone:606-329-0477
Mailing Address - Fax:606-326-0352
Practice Address - Street 1:351 RIVER HILL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7397
Practice Address - Country:US
Practice Address - Phone:606-329-0477
Practice Address - Fax:606-326-0352
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist