Provider Demographics
NPI:1003181199
Name:HOLMAN, KEVIN B (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:B
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-4144
Mailing Address - Country:US
Mailing Address - Phone:541-298-2055
Mailing Address - Fax:541-298-2060
Practice Address - Street 1:3300 W 6TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-4144
Practice Address - Country:US
Practice Address - Phone:541-298-2055
Practice Address - Fax:541-298-2060
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist