Provider Demographics
NPI:1740883867
Name:HEIDEL, KELSEY MARIE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:MARIE
Last Name:HEIDEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9197 READING RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3348
Mailing Address - Country:US
Mailing Address - Phone:513-733-8550
Mailing Address - Fax:513-733-3639
Practice Address - Street 1:9197 READING RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:OH
Practice Address - Zip Code:45215-3348
Practice Address - Country:US
Practice Address - Phone:513-733-8550
Practice Address - Fax:513-733-3639
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist