Provider Demographics
NPI:1821373523
Name:HOLMES, BRAD DUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:DUSTIN
Last Name:HOLMES
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 1:906 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2040
Mailing Address - Country:US
Mailing Address - Phone:601-684-7976
Mailing Address - Fax:601-684-5372
Practice Address - Street 1:906 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2040
Practice Address - Country:US
Practice Address - Phone:601-684-7976
Practice Address - Fax:601-684-5372
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist