Provider Demographics
NPI:1487965299
Name:HOLTZ, LOREN EUGENE (RPH)
Entity type:Individual
Prefix:MR
First Name:LOREN
Middle Name:EUGENE
Last Name:HOLTZ
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 1:11 W 65TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1842
Mailing Address - Country:US
Mailing Address - Phone:816-210-2480
Mailing Address - Fax:
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:SUITE 120
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-943-4879
Practice Address - Fax:816-943-4882
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist