Provider Demographics
NPI:1407267255
Name:HOLT, PATRICK LEWIS (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEWIS
Last Name:HOLT
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1494
Mailing Address - Country:US
Mailing Address - Phone:478-746-5842
Mailing Address - Fax:478-746-2662
Practice Address - Street 1:660 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1494
Practice Address - Country:US
Practice Address - Phone:478-746-5842
Practice Address - Fax:478-746-2662
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist