Provider Demographics
NPI:1023137254
Name:HOLOUBEK, GEORGE H JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:H
Last Name:HOLOUBEK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3319 LORTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2318
Mailing Address - Country:US
Mailing Address - Phone:563-359-6926
Mailing Address - Fax:
Practice Address - Street 1:4064 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3033
Practice Address - Country:US
Practice Address - Phone:563-359-3120
Practice Address - Fax:563-359-1137
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17112183500000X
CO12468183500000X
IL0051-286448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist