Provider Demographics
NPI:1073225207
Name:CHESNUTTE, KONNOR CHARLES (CPHT)
Entity type:Individual
Prefix:MR
First Name:KONNOR
Middle Name:CHARLES
Last Name:CHESNUTTE
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2632
Mailing Address - Country:US
Mailing Address - Phone:419-334-9220
Mailing Address - Fax:888-509-9959
Practice Address - Street 1:2221 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2632
Practice Address - Country:US
Practice Address - Phone:419-334-9220
Practice Address - Fax:888-509-9959
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09315404183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician