Provider Demographics
NPI:1588081343
Name:WHITCOMB, HOLLIS
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLIS
Other - Middle Name:WHITCOMB
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7317 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5918
Mailing Address - Country:US
Mailing Address - Phone:206-417-8066
Mailing Address - Fax:206-417-8076
Practice Address - Street 1:7317 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5918
Practice Address - Country:US
Practice Address - Phone:206-417-8066
Practice Address - Fax:206-417-8076
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010617183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric