MEDICARE: KEVIN CROSS 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	183500000X	Pharmacist	20795	NC

General Provider Information

NPI Number	:	1770881393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN CROSS PHARM.D.

Provider Business Mailing Address
First Line	:	223 ABBERLY CREST BLVD
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-6991
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 N BREAZEALE AVE
Second Line	:
City	:	MOUNT OLIVE
State	:	NC
Zip	:	28365-1105
Country	:	US
Telephone Number	:	919-658-2554
Fax Number	:

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

Provider Enumeration Date	:	03/06/2011
Last Update Date	:	03/06/2011

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