Healthcare Provider Details

I. General information

NPI: 1881511269
Provider Name (Legal Business Name): KELLY ELAINE WILSON HOLMES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-1822
US

IV. Provider business mailing address

5213 BROOK RD NW
LANCASTER OH
43130-9141
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number03129625
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: