Provider Demographics
NPI:1245458942
Name:HOLLINGSWORTH, ROGER ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ALAN
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6495 SE TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-7482
Mailing Address - Country:US
Mailing Address - Phone:503-848-4583
Mailing Address - Fax:503-848-4577
Practice Address - Street 1:6495 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7482
Practice Address - Country:US
Practice Address - Phone:503-848-4583
Practice Address - Fax:503-848-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6895183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROTH000Medicare UPIN