Provider Demographics
NPI:1518565241
Name:RAKO, KELLY LYNNE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:RAKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7558 BRIDGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-2500
Mailing Address - Country:US
Mailing Address - Phone:216-956-6964
Mailing Address - Fax:
Practice Address - Street 1:800 LOVELAND MADEIRA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2716
Practice Address - Country:US
Practice Address - Phone:513-677-3400
Practice Address - Fax:513-677-5196
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist