Individual provider Active NPI

Stephanie Ladale Holmes

  • Pharmacist
  • Huntington, WV
National Provider Identifier
1083210694
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RP0009698 Issued in WV
Practice address
505 20TH St
Huntington, WV 25703-1510
Phone
(304) 522-1035
Fax
(345) 525-8239
NPI assigned
Dec 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 03135956 OH
Pharmacist 183500000X RP0009698 WV Primary

Addresses

Primary practice location

505 20TH St
Huntington, WV 25703-1510

Mailing address

505 20TH St
Huntington, WV 25703-1510
Phone (304) 522-1035

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
03135956OHMDPharmacist
RP0009698WVMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia CVS Pharmacy LLC PastSince Dec 13, 2020 Accepting new patients
West Virginia CVS Pharmacy LLC PastSince Dec 13, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1083210694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 20TH ST",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257031510",
            "telephone_number": "304-522-1035",
            "fax_number": "304-525-8239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 20TH ST",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257031510",
            "telephone_number": "304-522-1035",
            "fax_number": "345-525-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "STEPHANIE",
        "middle_name": "LADALE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03135956",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WV",
            "license": "RP0009698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.