Healthcare Provider Details

I. General information

NPI: 1538146162
Provider Name (Legal Business Name): GLORIA A HOLSEYBROOK PHARMD, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 HAWK PKWY SUITE H-2
MONTROSE CO
81401-6461
US

IV. Provider business mailing address

1414 HAWK PKWY SUITE H-2
MONTROSE CO
81401-6461
US

V. Phone/Fax

Practice location:
  • Phone: 970-275-8387
  • Fax:
Mailing address:
  • Phone: 970-275-8387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number634
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: