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General NPI Number Information
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NPI Number | 1831104447
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Entity Type | Organization
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Legal Business Name | HOLT PHARMACY SERVICES, LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2018 CEDAR ST STE A
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City | HOLT
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State | MI
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Zip | 48842-1400
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Country | US
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Telephone | 517-694-9707
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Fax | 517-694-9713
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Provider Business Mailing Address
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Address Line | 2018 CEDAR ST STE A
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City | HOLT
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State | MI
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Zip | 48842-1400
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Country | US
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Telephone | 517-694-9707
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Fax | 517-694-9713
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JAYSON B BULMAHN
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Credential | RPH
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Telephone | 716-471-8067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301007439
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License Number State | MI
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