Provider Demographics
NPI:1447535505
Name:HOLDEN, AMY LYNN (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:HOLDEN
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 1:3800 SE 367TH CT
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-6745
Mailing Address - Country:US
Mailing Address - Phone:360-600-7385
Mailing Address - Fax:
Practice Address - Street 1:3328 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2436
Practice Address - Country:US
Practice Address - Phone:360-835-3303
Practice Address - Fax:360-835-7971
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00176801835P0018X
WAPH00015066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist