Provider Demographics
NPI:1457899056
Name:HOLUBY, WILLIAM DANE (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANE
Last Name:HOLUBY
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 1:615 W AVENUE L
Mailing Address - Street 2:OP PHARMACY - FIRST FL
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7211
Mailing Address - Country:US
Mailing Address - Phone:661-723-2056
Mailing Address - Fax:
Practice Address - Street 1:615 W AVENUE L
Practice Address - Street 2:OP PHARMACY - FIRST FL
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7211
Practice Address - Country:US
Practice Address - Phone:661-723-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist