Provider Demographics
NPI:1992795603
Name:HOLMAN, DAVID BRIAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:HOLMAN
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 1:669 W KARSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3314
Mailing Address - Country:US
Mailing Address - Phone:573-756-3503
Mailing Address - Fax:573-756-5946
Practice Address - Street 1:669 W KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3314
Practice Address - Country:US
Practice Address - Phone:573-756-8906
Practice Address - Fax:576-375-6594
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0237850001Medicare NSC