Provider Demographics
NPI:1275164212
Name:HOLT, LESLI DRU (RPH)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:DRU
Last Name:HOLT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAKE CAROLYN PKWY APT 4325
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3976
Mailing Address - Country:US
Mailing Address - Phone:817-366-8472
Mailing Address - Fax:
Practice Address - Street 1:6161 N STATE HIGHWAY 161 STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2220
Practice Address - Country:US
Practice Address - Phone:972-812-7559
Practice Address - Fax:972-871-0300
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist