Individual
KELLY MARIE HOTALING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
11650 S 73RD ST, PAPILLION, NE 68046-1500
(402) 597-5056
Mailing address
10359 S 125TH ST, PAPILLION, NE 68046-4361
(308) 325-4660
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
NE14372
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
612165
NABP
—
01
—
NE14372
LICENSE NUMBER
NE
Enumeration date
04/17/2019
Last updated
04/17/2019
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