Provider Demographics
NPI:1922361021
Name:UMHOLTZ, JOY M (BSPHARM)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:M
Last Name:UMHOLTZ
Suffix:
Gender:F
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 E 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-2654
Mailing Address - Country:US
Mailing Address - Phone:316-683-5621
Mailing Address - Fax:316-652-1756
Practice Address - Street 1:6217 E 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2654
Practice Address - Country:US
Practice Address - Phone:316-683-5621
Practice Address - Fax:316-652-1756
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS12504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist