MEDICARE: MR. MICHAEL A HOLTZ R.PH.

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	5302032772	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302032772	OTHER	MI	PHARMACIST LICENSE
2	5302032772	OTHER	MI	CONTROLLED SUBSTANCE LICE

General Provider Information

NPI Number	:	1679573364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL A HOLTZ R.PH.

Provider Business Mailing Address
First Line	:	12923 CANAL VIEW DR
Second Line	:
City	:	WAYLAND
State	:	MI
Zip	:	49348-9222
Country	:	US
Telephone Number	:	269-792-3790
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 124TH AVE
Second Line	:
City	:	SHELBYVILLE
State	:	MI
Zip	:	49344-9772
Country	:	US
Telephone Number	:	269-672-7774
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	09/11/2025

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