MEDICARE: VICTORIA RENEE HOLTS PHARM.D

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	48939	TX
2	183500000X	Pharmacist	17533	CO

General Provider Information

NPI Number	:	1518241496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA RENEE HOLTS PHARM.D

Provider Business Mailing Address
First Line	:	11658 IH 35
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233
Country	:	US
Telephone Number	:	210-599-0398
Fax Number	:	210-590-3785

Provider Business Practice Location Address
First Line	:	11658 N IH 35
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5305
Country	:	US
Telephone Number	:	210-599-0398
Fax Number	:	210-590-3785

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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