Provider Demographics
NPI:1336352640
Name:HOLST, GARY ALLEN (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ALLEN
Last Name:HOLST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11131 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1482
Mailing Address - Country:US
Mailing Address - Phone:913-234-4664
Mailing Address - Fax:913-234-4661
Practice Address - Street 1:11131 W 79TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1482
Practice Address - Country:US
Practice Address - Phone:913-234-4664
Practice Address - Fax:913-234-4661
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10795183500000X, 1835G0303X, 1835N1003X, 1835P1200X
MO41592183500000X, 1835G0303X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy