Provider Demographics
NPI:1235678871
Name:HOFFMANN, KELLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 SELLS AVE
Mailing Address - Street 2:APT H
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1365
Mailing Address - Country:US
Mailing Address - Phone:843-290-4455
Mailing Address - Fax:
Practice Address - Street 1:1109 SELLS AVE
Practice Address - Street 2:APT H
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1365
Practice Address - Country:US
Practice Address - Phone:843-290-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032302911835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology