Provider Demographics
NPI:1245853159
Name:HOLMES, MADISON (PHARMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:COMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:153 W WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3526
Mailing Address - Country:US
Mailing Address - Phone:850-368-9791
Mailing Address - Fax:
Practice Address - Street 1:153 W WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3526
Practice Address - Country:US
Practice Address - Phone:850-689-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist