Provider Demographics
NPI:1023534120
Name:HOLT, IAN (PHARMD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:HOLT
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 1:14120 GRANT ST APT 16-302
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6488
Mailing Address - Country:US
Mailing Address - Phone:304-575-1662
Mailing Address - Fax:
Practice Address - Street 1:711 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2668
Practice Address - Country:US
Practice Address - Phone:606-324-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010262183500000X
KY019490183500000X
COPHA.0023147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist