Provider Demographics
NPI:1861522666
Name:HOLLENBAUGH, KRISTE CHARLENE (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTE
Middle Name:CHARLENE
Last Name:HOLLENBAUGH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:KRISTE
Other - Middle Name:CHARLENE
Other - Last Name:RUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1750 GRATIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040
Mailing Address - Country:US
Mailing Address - Phone:810-364-6200
Mailing Address - Fax:810-364-3084
Practice Address - Street 1:1750 GRATIOT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040
Practice Address - Country:US
Practice Address - Phone:810-364-6200
Practice Address - Fax:810-364-3084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302028818OtherRPH LISCENCE NUMBER