Healthcare Provider Details

I. General information

NPI: 1124522800
Provider Name (Legal Business Name): KELLY MCNEAL PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 KAYLAS CT
ORLANDO FL
32817-4543
US

IV. Provider business mailing address

2057 KAYLAS CT
ORLANDO FL
32817-4543
US

V. Phone/Fax

Practice location:
  • Phone: 717-472-7733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30049582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: