Provider Demographics
NPI:1205442514
Name:MERHOLZ, KELLY ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MERHOLZ
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 1:2756 TONAWANDA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3033
Mailing Address - Country:US
Mailing Address - Phone:216-337-2729
Mailing Address - Fax:
Practice Address - Street 1:9885 ROCKSIDE RD STE 157
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-6272
Practice Address - Country:US
Practice Address - Phone:216-957-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist