=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780162990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL LOWE HOLMES RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 07/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2479 SOUTH CHURCH STREET ADDRESS LINE 2
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-2721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-570-2273
-----------------------------------------------------
Fax | 336-350-8534
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2479 S. CHURCH STREET ADDRESS LINE 2
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-570-2273
-----------------------------------------------------
Fax | 336-350-8534
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 12438
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------