Provider Demographics
NPI:1386932481
Name:ULRICH, HOLLY JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JEAN
Last Name:ULRICH
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 1:2505 1ST ST S
Mailing Address - Street 2:T-0661
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4215
Mailing Address - Country:US
Mailing Address - Phone:320-235-3023
Mailing Address - Fax:
Practice Address - Street 1:2505 1ST ST S
Practice Address - Street 2:T-0661
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4215
Practice Address - Country:US
Practice Address - Phone:320-235-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist