Provider Demographics
NPI:1225892482
Name:HOLSEN, JESSICA DOVE (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DOVE
Last Name:HOLSEN
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW WALNUT BLVD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3538
Mailing Address - Country:US
Mailing Address - Phone:541-215-2411
Mailing Address - Fax:
Practice Address - Street 1:2300 NW WALNUT BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3538
Practice Address - Country:US
Practice Address - Phone:541-768-6554
Practice Address - Fax:541-768-5210
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00195751835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0019575-POtherPRECEPTOR
ORRPH-0019575OtherPHARMACIST LICENSE