Provider Demographics
NPI:1790059004
Name:BLACKLEY, HOLLY POOLE (RPH)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:POOLE
Last Name:BLACKLEY
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 1:5805 WOODMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2003
Mailing Address - Country:US
Mailing Address - Phone:513-602-6583
Mailing Address - Fax:
Practice Address - Street 1:5805 WOODMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2003
Practice Address - Country:US
Practice Address - Phone:513-602-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist