Provider Demographics
NPI:1003133133
Name:HOLT, MICHAEL (R PH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 OLD TOWNE RD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6062
Mailing Address - Country:US
Mailing Address - Phone:843-766-5593
Mailing Address - Fax:843-766-9787
Practice Address - Street 1:1115 OLD TOWNE RD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6062
Practice Address - Country:US
Practice Address - Phone:843-766-5593
Practice Address - Fax:843-766-9787
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist