Provider Demographics
NPI:1780359448
Name:HOLT, JEAN ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:HOLT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:TINSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:402 N CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-2022
Mailing Address - Country:US
Mailing Address - Phone:620-704-8300
Mailing Address - Fax:
Practice Address - Street 1:3011 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2546
Practice Address - Country:US
Practice Address - Phone:620-231-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist