Provider Demographics
NPI:1942476049
Name:HOLTER, BEN ALAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:ALAN
Last Name:HOLTER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5236
Mailing Address - Fax:
Practice Address - Street 1:310 W UNION ST STE 101
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2312
Practice Address - Country:US
Practice Address - Phone:740-447-9201
Practice Address - Fax:740-447-9205
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328569183500000X
OH03-3-28569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist