MEDICARE: KELLI HOLDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03233662	OH

General Provider Information

NPI Number	:	1174150742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI HOLDEN

Provider Business Mailing Address
First Line	:	684 E LAKE LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 EASTGATE BLVD STE 500
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1256
Country	:	US
Telephone Number	:	513-943-6340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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Directions to “ KELLI HOLDEN ” Practice Location

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