Provider Demographics
NPI:1356604870
Name:VIETOR, HOLLY (RPH)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:VIETOR
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 1:2610 S DOUGLAS HWY
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6468
Mailing Address - Country:US
Mailing Address - Phone:307-687-2996
Mailing Address - Fax:307-686-6153
Practice Address - Street 1:2610 S DOUGLAS HWY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6468
Practice Address - Country:US
Practice Address - Phone:307-687-2996
Practice Address - Fax:307-686-6153
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14154183500000X
WY4279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist