Healthcare Provider Details

I. General information

NPI: 1790611606
Provider Name (Legal Business Name): OLIVIA FISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E MAIN ST
HEBRON OH
43025-8006
US

IV. Provider business mailing address

600 E MAIN ST
HEBRON OH
43025-8006
US

V. Phone/Fax

Practice location:
  • Phone: 740-928-2152
  • Fax:
Mailing address:
  • Phone: 740-928-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03445913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: