Provider Demographics
NPI:1336730035
Name:FAHEY, HOLLY (PHARMD, BCGP)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2466
Mailing Address - Country:US
Mailing Address - Phone:614-214-8981
Mailing Address - Fax:
Practice Address - Street 1:200 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5715
Practice Address - Country:US
Practice Address - Phone:614-227-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03131930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist