MEDICARE: DAVID TIMOTHY HOLCOMB PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH016499	GA

General Provider Information

NPI Number	:	1013511146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID TIMOTHY HOLCOMB PHARMD

Provider Business Mailing Address
First Line	:	3719 HIGH GABLES W
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-4503
Country	:	US
Telephone Number	:	678-371-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3021
Country	:	US
Telephone Number	:	770-965-1979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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