Healthcare Provider Details

I. General information

NPI: 1669038030
Provider Name (Legal Business Name): KELSTON J'KAY FERRELL PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2019
Last Update Date: 05/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 MALL DR
NORTH CHARLESTON SC
29406-6514
US

IV. Provider business mailing address

2470 MALL DR
NORTH CHARLESTON SC
29406-6514
US

V. Phone/Fax

Practice location:
  • Phone: 843-207-4721
  • Fax:
Mailing address:
  • Phone: 843-207-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number240101021158450
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: