Healthcare Provider Details

I. General information

NPI: 1588020325
Provider Name (Legal Business Name): KELLY HINES CROSS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MAIN AVE SW
HICKORY NC
28602-2601
US

IV. Provider business mailing address

PO BOX 1467
HICKORY NC
28603-1467
US

V. Phone/Fax

Practice location:
  • Phone: 828-780-8510
  • Fax: 828-780-8520
Mailing address:
  • Phone: 828-780-8510
  • Fax: 828-780-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11497
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: