Healthcare Provider Details

I. General information

NPI: 1336352640
Provider Name (Legal Business Name): GARY ALLEN HOLST R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11131 W 79TH ST
LENEXA KS
66214-1482
US

IV. Provider business mailing address

11131 W 79TH ST
LENEXA KS
66214-1482
US

V. Phone/Fax

Practice location:
  • Phone: 913-234-4664
  • Fax: 913-234-4661
Mailing address:
  • Phone: 913-234-4664
  • Fax: 913-234-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10795
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41592
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number10795
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number41592
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number10795
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number41592
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number10795
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number41592
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: