Provider Demographics
NPI:1184210361
Name:HOLMAN, MARTHA MCFALL (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MCFALL
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E FM 2449
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-7546
Mailing Address - Country:US
Mailing Address - Phone:940-479-0111
Mailing Address - Fax:
Practice Address - Street 1:250 E FM 2449
Practice Address - Street 2:
Practice Address - City:PONDER
Practice Address - State:TX
Practice Address - Zip Code:76259-7546
Practice Address - Country:US
Practice Address - Phone:940-479-0111
Practice Address - Fax:940-479-0711
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist