Provider Demographics
NPI:1568462430
Name:CONWAY, DENISE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18787 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9586
Mailing Address - Country:US
Mailing Address - Phone:740-397-1420
Mailing Address - Fax:740-397-2454
Practice Address - Street 1:1451 YAUGER RD
Practice Address - Street 2:SUITE 1H
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8097
Practice Address - Country:US
Practice Address - Phone:740-397-1420
Practice Address - Fax:740-397-2454
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH24190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0429902Medicaid
OH1568462430OtherNPI