Provider Demographics
NPI:1083994412
Name:HOLT, TARYN RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:RENEE
Last Name:HOLT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S 4TH ST
Mailing Address - Street 2:APT 908
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2151
Mailing Address - Country:US
Mailing Address - Phone:574-780-2046
Mailing Address - Fax:
Practice Address - Street 1:9459 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2219
Practice Address - Country:US
Practice Address - Phone:502-425-8573
Practice Address - Fax:502-425-3443
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist