Provider Demographics
NPI:1679117303
Name:HOLZER, JENNIFER MARY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:HOLZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9429 WHOOPING CRANE WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-1861
Mailing Address - Country:US
Mailing Address - Phone:239-641-1964
Mailing Address - Fax:
Practice Address - Street 1:5420 JULIET BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2628
Practice Address - Country:US
Practice Address - Phone:239-254-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist