Provider Demographics
NPI:1013050350
Name:HOLT, JEREMY CURTIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:CURTIS
Last Name:HOLT
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 1:7550 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5429
Mailing Address - Country:US
Mailing Address - Phone:206-622-3565
Mailing Address - Fax:206-382-9727
Practice Address - Street 1:616 OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1717
Practice Address - Country:US
Practice Address - Phone:206-622-3565
Practice Address - Fax:206-382-9737
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00050020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00050020OtherPHARMACY LICENSE