Provider Demographics
NPI:1487258661
Name:HOLT, GREGORY CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:CHARLES
Last Name:HOLT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1046
Mailing Address - Country:US
Mailing Address - Phone:574-935-5697
Mailing Address - Fax:574-935-3083
Practice Address - Street 1:1900 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1046
Practice Address - Country:US
Practice Address - Phone:574-935-5697
Practice Address - Fax:574-935-3083
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016446A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist