Provider Demographics
NPI:1245812346
Name:HOLT, ROBERT WILLIAM
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 DOVE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6402
Mailing Address - Country:US
Mailing Address - Phone:501-258-4412
Mailing Address - Fax:
Practice Address - Street 1:58 DOVE CREEK CIR
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6402
Practice Address - Country:US
Practice Address - Phone:501-258-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR08480183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAR08480OtherARKANSAS STATE BOARD OF PHARMACY