MEDICARE: MRS. KELLY K RAMSEY RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	VA00016069	WA

General Provider Information

NPI Number	:	1144204801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY K RAMSEY RPT

Provider Business Mailing Address
First Line	:	717 FIR AVE
Second Line	:	PO BOX
City	:	SULTAN
State	:	WA
Zip	:	98294-9701
Country	:	US
Telephone Number	:	360-793-1988
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 FIR AVE
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-9701
Country	:	US
Telephone Number	:	360-793-1988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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