1053418988 NPI number — HOLCOMB PHARMACY PC

Table of content: (NPI 1053418988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053418988 NPI number — HOLCOMB PHARMACY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLCOMB PHARMACY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOLCOMB PHARMACY PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053418988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 S 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN BOW
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68822-2456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-872-5231
Provider Business Mailing Address Fax Number:
308-872-2377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 S 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN BOW
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68822-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-872-5231
Provider Business Practice Location Address Fax Number:
308-872-2377
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLCOMB
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
308-872-5231

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2819 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2053180 . This is a "PK" identifier . This identifiers is of the category "OTHER".