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General NPI Number Information
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NPI Number | 1366857732
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Entity Type | Individual
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Provider Name | DR. KELLIE ROUGH
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Gender | Female
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 901 NC HIGHWAY 16 S
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City | TAYLORSVILLE
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State | NC
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Zip | 28681-8941
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Country | US
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Telephone | 828-632-4181
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Fax | 828-635-1485
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Provider Business Mailing Address
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Address Line | 901 NC HIGHWAY 16 S
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City | TAYLORSVILLE
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State | NC
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Zip | 28681-8941
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Country | US
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Telephone | 828-632-4181
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Fax | 828-635-1485
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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 | 14410
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License Number State | NC
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