Healthcare Provider Details

I. General information

NPI: 1861522666
Provider Name (Legal Business Name): KRISTE CHARLENE HOLLENBAUGH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTE CHARLENE RUBLE RPH

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GRATIOT BLVD
MARYSVILLE MI
48040
US

IV. Provider business mailing address

1750 GRATIOT BLVD
MARYSVILLE MI
48040
US

V. Phone/Fax

Practice location:
  • Phone: 810-364-6200
  • Fax: 810-364-3084
Mailing address:
  • Phone: 810-364-6200
  • Fax: 810-364-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: