MR. JACK L HOLT (NPI# 1104168624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104168624 |
| Entity Type | Individual |
| Full Name | MR. JACK L HOLT |
| Credential | RPH |
| Practice Address |
916 W Evergreen Blvd Vancouver WA 98660-3035 |
| Practice Telephone | 3602132232 |
| Practice Fax Number | 3602132238 |
| Mailing Telephone | 3602132232 |
| Mailing Fax Number | 3602132238 |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2013-04-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | RPH-0007279 | OR | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | PHARMACIST LICENSE | RPH-0007279 | 01 |
| OR | PHARMACIST PRECEPTOR LICENSE | RPH-0007279-P | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629293618 | Jack Robert Holt | Dentist | 1213 Coffee Rd, Suite M, Modesto, CA 95355-4229 | 2007-04-16 |
| Street Address |
916 W EVERGREEN BLVD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98660-3035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235481706 | Lesley Ann Kruger | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2012-10-09 |
| 1528619608 | Roger Scott Will | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2019-09-20 |
| 1104305077 | Nha Le | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2018-08-10 |
| 1972028801 | Chelsea Leigh Gwinn | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2017-08-11 |
| 1508220211 | Charles R Parsons | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2016-04-08 |
| 1639533482 | Meredith A Amoruso | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2016-04-07 |
| 1548626971 | Scott Ellefson | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660 | 2016-01-14 |
| 1093117764 | Linda Schwartz | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660 | 2014-09-24 |
| 1225371362 | Chris G Wuestefeld | Pharmacist | 916 W Evergreen Blvd, Vancouver, WA 98660-3035 | 2013-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538779137 | Peacehealth Networks On Demand, LLC | Non-Pharmacy Dispensing Site | 781 W Columbia Way, Vancouver, WA 98660 | 2020-08-07 |
| 1538641527 | Melissa Molly Sivaram | Counselor | 1012 Esther St, Vancouver, WA 98660 | 2018-09-05 |
| 1679082598 | Christopher Lewis Schwab | Peer Specialist | 5197 Nw Lower River Rd, Vancouver, WA 98660 | 2017-09-22 |
| 1023560141 | Disabled Veterans Hawaii LLC | Durable Medical Equipment & Medical Supplies | 4817 Nw Fruit Valley Road, Suite 100, Vancouver, WA 98660 | 2016-10-25 |
| 1023493004 | Laura Nicole Wood | Counselor | 1104 Main St Ste M100, Vancouver, WA 98660 | 2015-07-20 |
| 1790034627 | Clark County Juvenile Court | Marriage & Family Therapist | 500 W 11th Street, Vancouver, WA 98660 | 2012-09-06 |
| 1538439104 | Hutton Chiropractic Clinic Inc | Chiropractor | 703 Broadway Street, Ste 650, Vancouver, WA 98660 | 2012-01-12 |
| 1134422629 | Brenda Marie Bible | Social Worker | 101 E 8th St Ste 110, Vancouver, WA 98660 | 2010-12-06 |
| 1871895409 | Donna L Benedicktus | Contractor | 210 E Evergreen Blvd, Vancouver, WA 98660 | 2010-12-02 |
| 1992007801 | Peter Ray Hasemeier | Massage Therapist | 805 Broadway St., Vancouver, WA 98660 | 2010-11-29 |
| Find all providers in zip 98660 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639797798 | Jordan Kathleen Hurley | Pharmacist | 3905 Ne 89th Way, Vancouver, WA 98665-5329 | 2020-07-06 |
| 1639793474 | Christina Putnam | Pharmacist | 16811 Se Mcgillivray Blvd Ste 101, Vancouver, WA 98683-3404 | 2020-06-06 |
| 1306404041 | Couper D Millar | Pharmacist | 14313 Ne 20th Ave Ste 109, Vancouver, WA 98686-1487 | 2019-05-29 |
| 1811472780 | Dang Hai Pham | Pharmacist | 4110 Ne 127th Ave, Vancouver, WA 98682-6848 | 2018-09-26 |
| 1972095636 | Merna Saied | Pharmacist | 306 Se 169th Ave, Vancouver, WA 98684-8411 | 2018-05-30 |
| 1245741008 | Courtney Louie | Pharmacist | 7819 Se 17th St, Vancouver, WA 98664-1783 | 2017-10-19 |
| 1760912059 | Mai Thi Phuong Nguyen | Pharmacist | 6706 Ne 65th Ave, Vancouver, WA 98661-1509 | 2017-06-19 |
| 1821535840 | Mark Balyshev | Pharmacist | 2602 Se Bella Vista Rd, Vancouver, WA 98683-7616 | 2017-01-28 |
| 1407205263 | Jennifer Nadine Locsmandi | Pharmacist | 17701 Se Mill Plain Blvd, Apt 219, Vancouver, WA 98683-7549 | 2016-06-11 |
| 1275996027 | Eric J Lofgren | Pharmacist | 6926 E 4th Plain Blvd Ste B, Vancouver, WA 98661-7369 | 2016-03-30 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.