Healthcare Provider Details

I. General information

NPI: 1639149669
Provider Name (Legal Business Name): HOLLIE J WAKELYN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLIE J COOK

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

4718 PARKVIEW LANE
MOUNT VERNON WA
98274
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1578
  • Fax:
Mailing address:
  • Phone: 360-707-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60156204
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRI028359
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: