Provider Demographics
NPI:1740806256
Name:PROFFITT, KELLIE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:ELIZABETH
Last Name:PROFFITT
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 1:3636 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1407
Mailing Address - Country:US
Mailing Address - Phone:513-639-9920
Mailing Address - Fax:
Practice Address - Street 1:3636 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1407
Practice Address - Country:US
Practice Address - Phone:513-639-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021011183500000X
OH03438633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist