Provider Demographics
NPI:1093164048
Name:WRIGHT, KELLY JUSTINE (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JUSTINE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JUSTINE
Other - Last Name:HITESHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:918 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4110
Mailing Address - Country:US
Mailing Address - Phone:614-888-6366
Mailing Address - Fax:
Practice Address - Street 1:918 HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4110
Practice Address - Country:US
Practice Address - Phone:614-888-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03230382-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist