Healthcare Provider Details

I. General information

NPI: 1942476049
Provider Name (Legal Business Name): BEN ALAN HOLTER PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W UNION ST STE 101
ATHENS OH
45701-2312
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-447-9201
  • Fax: 740-447-9205
Mailing address:
  • Phone: 740-446-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328569
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-28569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: