Healthcare Provider Details

I. General information

NPI: 1992080063
Provider Name (Legal Business Name): KIRBY GENE HOLLAND RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 MINERAL POINT RD
MADISON WI
53717-2088
US

IV. Provider business mailing address

7810 MINERAL POINT RD
MADISON WI
53717-2088
US

V. Phone/Fax

Practice location:
  • Phone: 608-833-1222
  • Fax: 608-829-3783
Mailing address:
  • Phone: 608-833-1222
  • Fax: 608-829-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11716-040
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.037231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: