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General NPI Number Information
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NPI Number | 1720605470
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Entity Type | Individual
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Provider Name | BRIAN E. HOLSTINE RPH
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Gender | Male
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 301 PARK DR C/O CVS PHARMACY
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City | OWATONNA
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State | MN
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Zip | 55060-5639
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Country | US
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Telephone | 763-438-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 1449 COLLEEN AVE
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City | ARDEN HILLS
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State | MN
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Zip | 55112-1939
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Country | US
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Telephone | 763-438-2565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26016053
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License Number State | IN
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