MEDICARE: JEFFREY L HOLYCROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-2-12762	OH
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053386847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L HOLYCROSS

Provider Business Mailing Address
First Line	:	8200 STATE ROUTE 366
Second Line	:
City	:	RUSSELLS POINT
State	:	OH
Zip	:	43348
Country	:	US
Telephone Number	:	937-843-3700
Fax Number	:	973-843-2801

Provider Business Practice Location Address
First Line	:	8200 STATE ROUTE 366
Second Line	:
City	:	RUSSELLS POINT
State	:	OH
Zip	:	43348-9670
Country	:	US
Telephone Number	:	937-843-3700
Fax Number	:	973-843-2801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/24/2012

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Directions to “ JEFFREY L HOLYCROSS ” Practice Location

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