Provider Demographics
NPI:1366852006
Name:HOLCOMB, DWAINE SPENCER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DWAINE
Middle Name:SPENCER
Last Name:HOLCOMB
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 1:2628 IDA AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-4214
Mailing Address - Country:US
Mailing Address - Phone:801-828-6928
Mailing Address - Fax:
Practice Address - Street 1:6325 S GILMORE RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5159
Practice Address - Country:US
Practice Address - Phone:513-881-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-03
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020400591835P1200X
OH34329183500000X
KY017477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy