Provider Demographics
NPI:1053901728
Name:STRATTARD, HOLLY J A (RPH)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:J A
Last Name:STRATTARD
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:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0783
Mailing Address - Country:US
Mailing Address - Phone:207-657-6122
Mailing Address - Fax:
Practice Address - Street 1:310 CENTER RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-5447
Practice Address - Country:US
Practice Address - Phone:207-657-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist