MEDICARE: BEN UDO HOLZMANN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11139	CO

General Provider Information

NPI Number	:	1508151119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEN UDO HOLZMANN RPH

Provider Business Mailing Address
First Line	:	110 W MEADOWS DR
Second Line	:	T-2029
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-8744
Country	:	US
Telephone Number	:	970-945-8056
Fax Number	:	970-945-8056

Provider Business Practice Location Address
First Line	:	110 W MEADOWS DR
Second Line	:	T-2029
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-8744
Country	:	US
Telephone Number	:	970-945-8056
Fax Number	:	970-945-8056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2011
Last Update Date	:	06/10/2011

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