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General NPI Number Information
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NPI Number | 1326623422
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Entity Type | Individual
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Provider Name | KELLY BROOKBANK CANNAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 4777 E GALBRAITH RD
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City | CINCINNATI
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State | OH
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Zip | 45236-2725
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Country | US
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Telephone | 513-686-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 2604 BRIARCLIFFE AVE
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City | CINCINNATI
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State | OH
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Zip | 45212-1306
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Country | US
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Telephone | 151-353-2706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03236862
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License Number State | OH
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