Provider Demographics
NPI:1851946800
Name:AVERS, KATELYN SUE
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:SUE
Last Name:AVERS
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 1:2694 HESSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416-9516
Mailing Address - Country:US
Mailing Address - Phone:419-559-5624
Mailing Address - Fax:
Practice Address - Street 1:2020 W STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1554
Practice Address - Country:US
Practice Address - Phone:419-332-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist