Healthcare Provider Details

I. General information

NPI: 1396104824
Provider Name (Legal Business Name): MRS. JANET HOLTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

IV. Provider business mailing address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-2273
  • Fax: 573-564-5249
Mailing address:
  • Phone: 573-564-2273
  • Fax: 573-564-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041736
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: