Provider Demographics
NPI:1437376712
Name:HOLT, BILLY JOE
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 W MAIN ST
Mailing Address - Street 2:P.O. BOX 130
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1741
Mailing Address - Country:US
Mailing Address - Phone:931-823-5539
Mailing Address - Fax:931-823-5313
Practice Address - Street 1:1075 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1741
Practice Address - Country:US
Practice Address - Phone:931-823-5539
Practice Address - Fax:931-823-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist