Healthcare Provider Details

I. General information

NPI: 1932933777
Provider Name (Legal Business Name): DR. KELLY WYLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 E MAIN ST
AMELIA OH
45102-1993
US

IV. Provider business mailing address

43 E MAIN ST
AMELIA OH
45102-1993
US

V. Phone/Fax

Practice location:
  • Phone: 513-685-6033
  • Fax: 513-685-0040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: