Provider Demographics
NPI:1881350809
Name:HOLMES, KRYSTAL KYMBERLIE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:KYMBERLIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 PINEWOOD DR APT 2201
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1144
Mailing Address - Country:US
Mailing Address - Phone:313-269-2357
Mailing Address - Fax:
Practice Address - Street 1:3080 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4606
Practice Address - Country:US
Practice Address - Phone:409-926-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67574183500000X
IA23621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist