MEDICARE: MR. CLIFFORD E 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	148824-1701	UT

General Provider Information

NPI Number	:	1457450843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLIFFORD E HOLT RPH

Provider Business Mailing Address
First Line	:	495 N STATE ST
Second Line	:
City	:	LA VERKIN
State	:	UT
Zip	:	84745-5124
Country	:	US
Telephone Number	:	435-962-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	495 N STATE ST
Second Line	:
City	:	LA VERKIN
State	:	UT
Zip	:	84745-5124
Country	:	US
Telephone Number	:	435-962-2557
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/25/2008

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Directions to “ MR. CLIFFORD E HOLT RPH” Practice Location

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