MEDICARE: MR. BEVERLY G HOLT RPH

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	0202004970	VA

General Provider Information

NPI Number	:	1205134327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BEVERLY G HOLT RPH

Provider Business Mailing Address
First Line	:	2664 NEW MARKET RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-7408
Country	:	US
Telephone Number	:	804-795-5141
Fax Number	:	804-795-9887

Provider Business Practice Location Address
First Line	:	2664 NEW MARKET RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-7408
Country	:	US
Telephone Number	:	804-795-5141
Fax Number	:	804-795-9887

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

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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