Healthcare Provider Details

I. General information

NPI: 1336141035
Provider Name (Legal Business Name): KELLY P MASTERS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD SUITE 310
WINCHESTER VA
22601-2872
US

IV. Provider business mailing address

1775 N SECTOR CT
WINCHESTER VA
22601-2859
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-0744
  • Fax:
Mailing address:
  • Phone: 540-545-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202205843
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: