Provider Demographics
NPI:1114905536
Name:HOOLSEMA, PATRICIA (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HOOLSEMA
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 1:525 ROMENCE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3444
Mailing Address - Country:US
Mailing Address - Phone:269-329-3205
Mailing Address - Fax:269-329-3225
Practice Address - Street 1:525 ROMENCE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3444
Practice Address - Country:US
Practice Address - Phone:269-329-3205
Practice Address - Fax:269-329-3225
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist