Provider Demographics
NPI:1598167413
Name:HOLSTE, LEA ELISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ELISE
Last Name:HOLSTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:ELISE
Other - Last Name:ACUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:121 EUSTIS AVE
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735
Mailing Address - Country:US
Mailing Address - Phone:866-536-7612
Mailing Address - Fax:
Practice Address - Street 1:121 EUSTIS AVE
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735
Practice Address - Country:US
Practice Address - Phone:866-536-7612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20210183500000X
KS1-15283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist