Provider Demographics
NPI:1366738528
Name:VANHORN, MOLLIE LYNN
Entity type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:LYNN
Last Name:VANHORN
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 1:1717 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1452
Mailing Address - Country:US
Mailing Address - Phone:800-366-2690
Mailing Address - Fax:800-366-2690
Practice Address - Street 1:1717 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1452
Practice Address - Country:US
Practice Address - Phone:800-366-2690
Practice Address - Fax:800-366-2690
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist