Provider Demographics
NPI:1144249038
Name:HOLTEBECK, BRIAN JAMES (PHARMD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:HOLTEBECK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2765 BURLAWN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1919
Mailing Address - Country:US
Mailing Address - Phone:414-687-9226
Mailing Address - Fax:
Practice Address - Street 1:ZABLOCKI DEPARTMENT OF VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:5000 WEST NATIONAL AVENUE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-389-4276
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12937-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist