Provider Demographics
NPI:1902189848
Name:CROSS, HOLMES WARREN JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:HOLMES
Middle Name:WARREN
Last Name:CROSS
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
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Mailing Address - Street 1:790 WEST GRANADA BLVD.
Mailing Address - Street 2:WALGREENS
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5178
Mailing Address - Country:US
Mailing Address - Phone:386-672-7107
Mailing Address - Fax:386-673-2892
Practice Address - Street 1:790 WEST GRANADA BLVD.
Practice Address - Street 2:WALGREENS
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5178
Practice Address - Country:US
Practice Address - Phone:386-672-7107
Practice Address - Fax:386-673-2892
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPS21221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist