MEDICARE: TIMOTHY SAMUEL HOLMAN PHARM.D.

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	2008028401	MO

General Provider Information

NPI Number	:	1144544941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY SAMUEL HOLMAN PHARM.D.

Provider Business Mailing Address
First Line	:	3883 CONNECTICUT ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-4838
Country	:	US
Telephone Number	:	314-540-8139
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 EAGER RD
Second Line	:	SUITE 500A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1421
Country	:	US
Telephone Number	:	314-540-8139
Fax Number	:

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

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	11/10/2014

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