Provider Demographics
NPI:1144436577
Name:HOLLENBECK, HEIDI LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LYNN
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BRIGHAM STREET
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01452-1405
Mailing Address - Country:US
Mailing Address - Phone:508-612-5223
Mailing Address - Fax:
Practice Address - Street 1:750 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:RINDGE
Practice Address - State:NH
Practice Address - Zip Code:03461
Practice Address - Country:US
Practice Address - Phone:603-899-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24138183500000X
NH3183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist