Provider Demographics
NPI:1396461349
Name:HOLMES, JERRY (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:HOLMES
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 1:4225 FLEUR DRIVE STE 118
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321
Mailing Address - Country:US
Mailing Address - Phone:515-334-4293
Mailing Address - Fax:800-332-9547
Practice Address - Street 1:514 N SHUFFLETON ST
Practice Address - Street 2:
Practice Address - City:SIGOURNEY
Practice Address - State:IA
Practice Address - Zip Code:52591
Practice Address - Country:US
Practice Address - Phone:515-334-4293
Practice Address - Fax:800-332-9548
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA181031835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric