MEDICARE: DR. CARL ANDREW HOLDER 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	PD-09898	AR

General Provider Information

NPI Number	:	1265028799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL ANDREW HOLDER PHARMD

Provider Business Mailing Address
First Line	:	5308 JFK BLVD STE 3
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6779
Country	:	US
Telephone Number	:	501-907-2095
Fax Number	:	501-907-2097

Provider Business Practice Location Address
First Line	:	5308 JFK BLVD STE 3
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6779
Country	:	US
Telephone Number	:	501-907-2095
Fax Number	:	501-907-2097

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

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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