Provider Demographics
NPI:1295813897
Name:HOLT, RICHARD A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:HOLT
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 1:4577 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2508
Mailing Address - Country:US
Mailing Address - Phone:315-622-6107
Mailing Address - Fax:315-622-6151
Practice Address - Street 1:4577 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2508
Practice Address - Country:US
Practice Address - Phone:315-622-6107
Practice Address - Fax:315-622-6151
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047331183500000X
FLPS42354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist