Provider Demographics
NPI:1144544941
Name:HOLMAN, TIMOTHY SAMUEL (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SAMUEL
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3883 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4838
Mailing Address - Country:US
Mailing Address - Phone:314-540-8139
Mailing Address - Fax:
Practice Address - Street 1:8300 EAGER RD
Practice Address - Street 2:SUITE 500A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1421
Practice Address - Country:US
Practice Address - Phone:314-540-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist