Healthcare Provider Details

I. General information

NPI: 1255599858
Provider Name (Legal Business Name): JUDITH NADINE HOLZAEPFEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WINTHROP CT
HURON OH
44839-1468
US

IV. Provider business mailing address

605 WINTHROP CT
HURON OH
44839-1468
US

V. Phone/Fax

Practice location:
  • Phone: 419-433-6767
  • Fax:
Mailing address:
  • Phone: 419-433-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12215
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number12215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: