Provider Demographics
NPI:1528695921
Name:WALDECKER, HOLLY SUE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:SUE
Last Name:WALDECKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3160
Mailing Address - Country:US
Mailing Address - Phone:440-353-1601
Mailing Address - Fax:440-353-1608
Practice Address - Street 1:34800 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3160
Practice Address - Country:US
Practice Address - Phone:440-353-1601
Practice Address - Fax:440-353-1608
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03136164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty