MEDICARE: KAYLA FAYE VECERA

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051302972	IL

General Provider Information

NPI Number	:	1386243111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA FAYE VECERA

Provider Business Mailing Address
First Line	:	100 N PARK ST
Second Line	:
City	:	HURST
State	:	IL
Zip	:	62949-1053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N GIANT CITY RD
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-6417
Country	:	US
Telephone Number	:	618-363-4142
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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Directions to “ KAYLA FAYE VECERA ” Practice Location

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