Provider Demographics
NPI:1215142849
Name:MCKELVEY, KRISTA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 TEWKSBURY RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3833
Mailing Address - Country:US
Mailing Address - Phone:614-440-0879
Mailing Address - Fax:
Practice Address - Street 1:1177 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6000
Practice Address - Country:US
Practice Address - Phone:614-430-2445
Practice Address - Fax:614-430-2449
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist