Provider Demographics
NPI:1922617307
Name:HOLDEMAN, KYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:HOLDEMAN
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 1:2013 LANTERN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6010
Mailing Address - Country:US
Mailing Address - Phone:859-575-5010
Mailing Address - Fax:859-575-5065
Practice Address - Street 1:2013 LANTERN RIDGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-6010
Practice Address - Country:US
Practice Address - Phone:859-575-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0213521835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy