Provider Demographics
NPI:1023492444
Name:HOLST, ROSS MICHAEL
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:MICHAEL
Last Name:HOLST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-0580
Mailing Address - Country:US
Mailing Address - Phone:913-369-2100
Mailing Address - Fax:913-369-2101
Practice Address - Street 1:760 NORTHSTAR CT
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-8933
Practice Address - Country:US
Practice Address - Phone:913-369-2100
Practice Address - Fax:913-369-2101
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist