Provider Demographics
NPI:1740220425
Name:PODKONJAK, KELLIE JEANNE BRION (RPH)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:JEANNE BRION
Last Name:PODKONJAK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4816
Mailing Address - Country:US
Mailing Address - Phone:303-399-1426
Mailing Address - Fax:
Practice Address - Street 1:7600 E. EASTMAN
Practice Address - Street 2:C/O HMC
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:303-752-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist