Healthcare Provider Details

I. General information

NPI: 1144436577
Provider Name (Legal Business Name): HEIDI LYNN HOLLENBECK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 US HIGHWAY 202
RINDGE NH
03461
US

IV. Provider business mailing address

38 BRIGHAM STREET
HUBBARDSTON MA
01452-1405
US

V. Phone/Fax

Practice location:
  • Phone: 603-899-6965
  • Fax:
Mailing address:
  • Phone: 508-612-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24138
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3183
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: