Provider Demographics
NPI:1366647174
Name:HOLST, VICTORIA L (RPH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:HOLST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11131 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1482
Mailing Address - Country:US
Mailing Address - Phone:913-234-4664
Mailing Address - Fax:913-234-4665
Practice Address - Street 1:11131 W 79TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1482
Practice Address - Country:US
Practice Address - Phone:913-234-4664
Practice Address - Fax:913-234-4665
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10560183500000X
MO41049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10560OtherPHARMACIST LICENSE
MO41049OtherPHARMACIST LICENSE