Provider Demographics
NPI:1407974207
Name:HOLLSTEIN, KELLY L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:HOLLSTEIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8201 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516
Mailing Address - Country:US
Mailing Address - Phone:402-420-3541
Mailing Address - Fax:402-420-3541
Practice Address - Street 1:2135 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4592
Practice Address - Country:US
Practice Address - Phone:515-964-7000
Practice Address - Fax:515-635-3053
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20403183500000X
NE12697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist