Provider Demographics
NPI:1649934316
Name:CHILES, KELLI LYNN (RPH)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:CHILES
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 1:1250 DEARBORN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4767
Mailing Address - Country:US
Mailing Address - Phone:614-840-3571
Mailing Address - Fax:866-690-8967
Practice Address - Street 1:1250 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-4767
Practice Address - Country:US
Practice Address - Phone:614-840-3571
Practice Address - Fax:866-690-8967
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist