Healthcare Provider Details

I. General information

NPI: 1922617307
Provider Name (Legal Business Name): KYLE HOLDEMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 LANTERN RIDGE DR
RICHMOND KY
40475-6010
US

IV. Provider business mailing address

2013 LANTERN RIDGE DR
RICHMOND KY
40475-6010
US

V. Phone/Fax

Practice location:
  • Phone: 859-575-5010
  • Fax:
Mailing address:
  • Phone: 859-575-5010
  • Fax: 859-575-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number021352
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: