MEDICARE: DR. KELLY P MASTERS PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	0202205843	VA

General Provider Information

NPI Number	:	1336141035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY P MASTERS PHARM.D.

Provider Business Mailing Address
First Line	:	1775 N SECTOR CT
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2859
Country	:	US
Telephone Number	:	540-545-7281
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 CAMPUS BLVD
Second Line	:	SUITE 310
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2872
Country	:	US
Telephone Number	:	540-667-0744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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