| NPI | 1285132720 |
|---|---|
| Former Name | HOLLY RYAN VIETZKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH RPH.03334439-3) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP449975) |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2018-01-30 |