Provider Demographics
NPI:1396104824
Name:HOLTMAN, JANET
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:HOLTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N STURGEON ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1426
Mailing Address - Country:US
Mailing Address - Phone:573-564-2273
Mailing Address - Fax:573-564-5249
Practice Address - Street 1:806 N STURGEON ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-1426
Practice Address - Country:US
Practice Address - Phone:573-564-2273
Practice Address - Fax:573-564-5249
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist