Provider Demographics
NPI:1194358903
Name:HOLMES, ALEX CLIFFORD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:CLIFFORD
Last Name:HOLMES
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 1:607 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2201
Mailing Address - Country:US
Mailing Address - Phone:920-356-0148
Mailing Address - Fax:
Practice Address - Street 1:607 PARK AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2201
Practice Address - Country:US
Practice Address - Phone:920-356-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18825-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist