Provider Demographics
NPI:1447853767
Name:CONOVER, HOLLY SUE
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:SUE
Last Name:CONOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16529 STATE ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-9267
Mailing Address - Country:US
Mailing Address - Phone:419-673-0777
Mailing Address - Fax:419-673-0777
Practice Address - Street 1:987 E COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1650
Practice Address - Country:US
Practice Address - Phone:419-673-0731
Practice Address - Fax:419-673-0731
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03118949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist