Healthcare Provider Details

I. General information

NPI: 1518310564
Provider Name (Legal Business Name): HOLLY NICOLE RABIDEAU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 QUARRY RD ROOM 2726A
PALO ALTO CA
94304-1416
US

IV. Provider business mailing address

213 QUARRY RD ROOM 2726A
PALO ALTO CA
94304-1416
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-5126
  • Fax:
Mailing address:
  • Phone: 650-721-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72050
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0020731
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3152986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: