Provider Demographics
NPI:1174113369
Name:HOLDEN, THOMAS K (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:HOLDEN
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 1:359 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-2368
Mailing Address - Country:US
Mailing Address - Phone:765-654-4300
Mailing Address - Fax:765-659-3238
Practice Address - Street 1:359 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-2368
Practice Address - Country:US
Practice Address - Phone:765-654-4300
Practice Address - Fax:765-659-3238
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014518A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201338170AMedicaid