MEDICARE: DR. TED ANTHONY HOLMES III 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	PS67420	FL

General Provider Information

NPI Number	:	1306676408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED ANTHONY HOLMES III RPH

Provider Business Mailing Address
First Line	:	9100 BALDRIDGE RD APT 11321
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-9468
Country	:	US
Telephone Number	:	601-917-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	8383 N DAVIS HWY # 494-3212
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-6039
Country	:	US
Telephone Number	:	850-494-3212
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/09/2024

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