Provider Demographics
NPI:1154743888
Name:SWEET, CONNIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:SWEET
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 1:7150 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1412
Mailing Address - Country:US
Mailing Address - Phone:937-237-4610
Mailing Address - Fax:937-237-4665
Practice Address - Street 1:7150 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1412
Practice Address - Country:US
Practice Address - Phone:937-237-4610
Practice Address - Fax:937-237-4665
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist