Provider Demographics
NPI:1942527320
Name:HOLME, KEITH R (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:HOLME
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 JACKSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2523
Mailing Address - Country:US
Mailing Address - Phone:763-441-1353
Mailing Address - Fax:763-441-9004
Practice Address - Street 1:323 JACKSON AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2523
Practice Address - Country:US
Practice Address - Phone:763-441-1353
Practice Address - Fax:763-441-9004
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist