Provider Demographics
NPI:1689273666
Name:NELIS, MADISON KAYE (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KAYE
Last Name:NELIS
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11390 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2313
Mailing Address - Country:US
Mailing Address - Phone:513-247-7760
Mailing Address - Fax:
Practice Address - Street 1:11390 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2313
Practice Address - Country:US
Practice Address - Phone:513-247-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020734183500000X
OH03438645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist