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General NPI Number Information
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NPI Number | 1114312428
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Entity Type | Individual
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Provider Name | KAYLA MASSO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 300 S KINGS HWY
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-4102
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Country | US
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Telephone | 843-626-2214
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Fax |
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Provider Business Mailing Address
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Address Line | 717 SANIBEL CIR
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-1324
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Country | US
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Telephone | 843-655-7596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35927
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License Number State | SC
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