Provider Demographics
NPI:1699326801
Name:WOLSTENHOLME, ALESSA NICOLE
Entity type:Individual
Prefix:
First Name:ALESSA
Middle Name:NICOLE
Last Name:WOLSTENHOLME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALESSA
Other - Middle Name:NICOLE
Other - Last Name:GRIEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8300 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-6312
Mailing Address - Country:US
Mailing Address - Phone:941-378-2029
Mailing Address - Fax:
Practice Address - Street 1:8300 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241
Practice Address - Country:US
Practice Address - Phone:941-378-2029
Practice Address - Fax:941-377-6359
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist