Provider Demographics
NPI:1487252318
Name:GRIPKA, HOLLY (PHARMD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GRIPKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15415 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-8237
Mailing Address - Country:US
Mailing Address - Phone:913-724-3666
Mailing Address - Fax:913-724-3667
Practice Address - Street 1:15415 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:BASEHOR
Practice Address - State:KS
Practice Address - Zip Code:66007-8237
Practice Address - Country:US
Practice Address - Phone:913-724-3666
Practice Address - Fax:913-724-3667
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist