Provider Demographics
NPI:1003036328
Name:HOLT JR, WALTER L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:L
Last Name:HOLT JR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 W HIGHTOWER TRL
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1822
Mailing Address - Country:US
Mailing Address - Phone:404-498-1278
Mailing Address - Fax:404-498-1112
Practice Address - Street 1:1600 CLIFTON RD CENTERS FOR DISEAE CONTROL AND PREVENT
Practice Address - Street 2:MS-73 RM 5004
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30333
Practice Address - Country:US
Practice Address - Phone:404-498-1278
Practice Address - Fax:404-498-1112
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS240021835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy