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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10795183500000X, 1835G0303X, 1835N1003X, 1835P1200X
MO41592183500000X, 1835G0303X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy