Healthcare Provider Details

I. General information

NPI: 1821684341
Provider Name (Legal Business Name): KACI MICHELLE RAINEY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KACI MICHELLE SANDERS

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LOCUST ST
LYMAN SC
29365-1503
US

IV. Provider business mailing address

101 LOCUST ST
LYMAN SC
29365-1503
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-1040
  • Fax: 864-949-0461
Mailing address:
  • Phone: 864-439-1040
  • Fax: 864-949-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number20515
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: