MEDICARE: DR. EVAN GRANT HOLBROOK 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	03338176	OH

General Provider Information

NPI Number	:	1518582733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN GRANT HOLBROOK PHARMD

Provider Business Mailing Address
First Line	:	562 MAIN ST
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-3222
Country	:	US
Telephone Number	:	513-867-0252
Fax Number	:

Provider Business Practice Location Address
First Line	:	562 MAIN ST
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-3222
Country	:	US
Telephone Number	:	513-867-0252
Fax Number	:

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

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/12/2020

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