MEDICARE: KEVIN WILLIAM HOLTZMAN PHARM.D., RPH

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	RPH031600	GA

General Provider Information

NPI Number	:	1134775984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WILLIAM HOLTZMAN PHARM.D., RPH

Provider Business Mailing Address
First Line	:	8272 DREAM BOAT DR UNIT 1128
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2571
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 BRADLEY PARK DR STE 600
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3625
Country	:	US
Telephone Number	:	706-571-3426
Fax Number	:

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

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	08/16/2019

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