Healthcare Provider Details

I. General information

NPI: 1750425187
Provider Name (Legal Business Name): KELLY MCCOY HAPNER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

14270 CROSS CREEK RD
UPATOI GA
31829-1829
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1495
  • Fax:
Mailing address:
  • Phone: 706-565-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH021344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: