Individual
MR. LES JAY HOLUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4823 S HIGHWAY 95, FORT MOHAVE, AZ 86426-8314
(928) 704-4443
Mailing address
2234 SUNRISE TRL, BULLHEAD CITY, AZ 86442-4409
(928) 201-5374
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
S012947
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D01684094
DRIVERS LICENSE
AZ
Enumeration date
12/01/2021
Last updated
12/01/2021
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