Provider Demographics
NPI:1144945395
Name:HOLTHUS, HEIDI LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LEE
Last Name:HOLTHUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 6TH ST NE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4415
Mailing Address - Country:US
Mailing Address - Phone:763-567-9235
Mailing Address - Fax:
Practice Address - Street 1:3605 ROUND LAKE BLVD NW
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-5003
Practice Address - Country:US
Practice Address - Phone:763-252-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist