Healthcare Provider Details

I. General information

NPI: 1356309298
Provider Name (Legal Business Name): KIMBERLY BRYANT-HOLMAN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NUCKOLLS RD
BOLIVAR TN
38008-1532
US

IV. Provider business mailing address

3395 OLD JACKSON RD
SOMERVILLE TN
38068-5829
US

V. Phone/Fax

Practice location:
  • Phone: 731-659-3740
  • Fax: 731-659-3741
Mailing address:
  • Phone: 901-465-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10469
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: