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NPI Code Detail

MEDICARE: MR. LES JAY HOLUB RPH

MEDICARE: MR. LES JAY HOLUB RPH
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
1101Y00000XCounselorS012947AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D01684094OTHERAZDRIVERS LICENSE

General Provider Information

NPI Number : 1780342345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LES JAY HOLUB RPH
Provider Business Mailing Address
First Line : 2234 SUNRISE TRL
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-4409
Country : US
Telephone Number : 928-201-5374
Fax Number :
Provider Business Practice Location Address
First Line : 4823 S HIGHWAY 95
Second Line :
City : FORT MOHAVE
State : AZ
Zip : 86426-8314
Country : US
Telephone Number : 928-704-4443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2021
Last Update Date : 12/01/2021

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Directions to “ MR. LES JAY HOLUB RPH” Practice Location

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