Provider Demographics
NPI:1891290755
Name:HOLCOMB, MICHAEL WILLIAM (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5824
Mailing Address - Country:US
Mailing Address - Phone:804-426-5723
Mailing Address - Fax:
Practice Address - Street 1:15412 PATRICK HENRY HWY
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4725
Practice Address - Country:US
Practice Address - Phone:804-561-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist