Healthcare Provider Details

I. General information

NPI: 1346844735
Provider Name (Legal Business Name): DAVID HOLMES RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S SEMORAN BLVD
ORLANDO FL
32807-1461
US

IV. Provider business mailing address

551 WHEATSTONE PL
ORLANDO FL
32835-4450
US

V. Phone/Fax

Practice location:
  • Phone: 407-381-3085
  • Fax:
Mailing address:
  • Phone: 618-322-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS60480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: