Provider Demographics
NPI:1285132720
Name:LOUTSENHIZER, HOLLY RYAN
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:RYAN
Last Name:LOUTSENHIZER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:RYAN
Other - Last Name:VIETZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:456 ROBINSON RD APT 901
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7073
Mailing Address - Country:US
Mailing Address - Phone:740-601-4610
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449975183500000X
OHRPH.03334439-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist