Provider Demographics
NPI:1316463599
Name:HOLTREY, CAROL LYNN (RPH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:HOLTREY
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 1:6480 COUNTY ROAD 76
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9436
Mailing Address - Country:US
Mailing Address - Phone:419-768-4753
Mailing Address - Fax:
Practice Address - Street 1:555 W MARION RD # 800
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1025
Practice Address - Country:US
Practice Address - Phone:419-947-9134
Practice Address - Fax:419-947-1304
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist