Provider Demographics
NPI:1720605470
Name:HOLSTINE, BRIAN E (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:HOLSTINE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 COLLEEN AVE
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1939
Mailing Address - Country:US
Mailing Address - Phone:763-438-2565
Mailing Address - Fax:
Practice Address - Street 1:301 PARK DR
Practice Address - Street 2:C/O CVS PHARMACY
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5639
Practice Address - Country:US
Practice Address - Phone:763-438-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist