Provider Demographics
NPI:1982225165
Name:HOLLAND, ADAM BURKE
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:BURKE
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 38TH ST APT 229
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3389
Mailing Address - Country:US
Mailing Address - Phone:515-313-3331
Mailing Address - Fax:
Practice Address - Street 1:2323 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3602
Practice Address - Country:US
Practice Address - Phone:712-322-3111
Practice Address - Fax:712-322-2715
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist