Healthcare Provider Details

I. General information

NPI: 1336098102
Provider Name (Legal Business Name): ROBERT JOHN HOLT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WEST MAIN STREET
SUNSET BEACH NC
28468
US

IV. Provider business mailing address

1002 WEST MAIN STREET
SUNSET BEACH NC
28468
US

V. Phone/Fax

Practice location:
  • Phone: 847-951-5064
  • Fax: 847-951-5064
Mailing address:
  • Phone: 847-951-5064
  • Fax: 847-951-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5149
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: