Provider Demographics
NPI:1699599662
Name:HOLBEN, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HOLBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KEASEY RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-9722
Mailing Address - Country:US
Mailing Address - Phone:724-355-8223
Mailing Address - Fax:
Practice Address - Street 1:117 KEASEY RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-9722
Practice Address - Country:US
Practice Address - Phone:724-355-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist