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NPI Code Detail

MEDICARE: KIMBERLY ERICKSON HOLDENER

MEDICARE: KIMBERLY ERICKSON HOLDENER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist14008-040WI
2183500000XPharmacist117641-2MN
3183500000XPharmacist26020453AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1117641-2OTHERMNPHARMACIST
214008-040OTHERWIPHARMACIST
326020453AOTHERINPHARMACIST

General Provider Information

NPI Number : 1508936105
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ERICKSON HOLDENER
Provider Business Mailing Address
First Line : 5240 SNAPDRAGON TRL
Second Line :
City : FITCHBURG
State : WI
Zip : 53711-7642
Country : US
Telephone Number : 608-263-1290
Fax Number :
Provider Business Practice Location Address
First Line : 600 HIGHLAND AVE
Second Line : PHARMACY DEPT. MAILCODE 1530
City : MADISON
State : WI
Zip : 53792-0001
Country : US
Telephone Number : 608-263-1290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/08/2007

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