Provider Demographics
NPI:1497807093
Name:HOLLIDAY, KRISTIE J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:J
Last Name:HOLLIDAY
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 1:5770 KARL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3604
Mailing Address - Country:US
Mailing Address - Phone:614-847-3784
Mailing Address - Fax:614-847-6171
Practice Address - Street 1:5770 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3604
Practice Address - Country:US
Practice Address - Phone:614-847-3784
Practice Address - Fax:614-847-6171
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03326993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3669439OtherNCPDP
OH2234844Medicaid