Provider Demographics
NPI:1427334549
Name:HOLM, THOMAS N
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:HOLM
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 1:100 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1434
Mailing Address - Country:US
Mailing Address - Phone:712-252-4669
Mailing Address - Fax:712-252-4906
Practice Address - Street 1:100 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1434
Practice Address - Country:US
Practice Address - Phone:712-252-4669
Practice Address - Fax:712-252-4906
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist