Provider Demographics
NPI:1831304963
Name:CONN, HOLLY ANN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:ANN
Last Name:CONN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11767 HELLTOWN ROAD
Mailing Address - Street 2:PO BOX 242
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1951
Practice Address - Country:US
Practice Address - Phone:937-845-2042
Practice Address - Fax:937-845-2062
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist