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NPI Code Detail

MEDICARE: KIERRA WATSON MCCRARY

MEDICARE: KIERRA WATSON MCCRARY
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
1183500000XPharmacistPS53835FL

General Provider Information

NPI Number : 1396121570
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIERRA WATSON MCCRARY
Provider Business Mailing Address
First Line : 3616 PINE OAK CIR APT 104
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-7440
Country : US
Telephone Number : 954-648-6679
Fax Number :
Provider Business Practice Location Address
First Line : 6790 DANIELS PKWY
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-7521
Country : US
Telephone Number : 239-433-4091
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2015
Last Update Date : 03/08/2021

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Directions to “ KIERRA WATSON MCCRARY ” Practice Location

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