Provider Demographics
NPI:1346522265
Name:HOLTZ, DREW (RPH)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:HOLTZ
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 1:5445 W DULIN LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9812
Mailing Address - Country:US
Mailing Address - Phone:417-732-8246
Mailing Address - Fax:417-732-8621
Practice Address - Street 1:1050 US HIGHWAY 60 E
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1569
Practice Address - Country:US
Practice Address - Phone:417-732-8246
Practice Address - Fax:417-732-8621
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO42205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist