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NPI Code Detail

MEDICARE: ROBERT J HOLT

MEDICARE: ROBERT J HOLT
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
1183500000XPharmacist9866OK

General Provider Information

NPI Number : 1053694307
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT J HOLT
Provider Business Mailing Address
First Line : 7101 W HEFNER RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73162-4503
Country : US
Telephone Number : 405-773-0711
Fax Number : 405-773-1204
Provider Business Practice Location Address
First Line : 7101 W HEFNER RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73162-4503
Country : US
Telephone Number : 405-773-0711
Fax Number : 405-773-1204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2011
Last Update Date : 09/22/2011

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