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NPI Code Detail

MEDICARE: KELLY MCRAE RPH

MEDICARE: KELLY MCRAE RPH
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
1183500000XPharmacist7833NC

General Provider Information

NPI Number : 1255785028
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MCRAE RPH
Provider Business Mailing Address
First Line : PO BOX 1071
Second Line : 200 EAST IVEY ST
City : LILLINGTON
State : NC
Zip : 27546-1071
Country : US
Telephone Number : 910-893-9320
Fax Number :
Provider Business Practice Location Address
First Line : 116 W DEPOT ST
Second Line :
City : ANGIER
State : NC
Zip : 27501-6696
Country : US
Telephone Number : 919-639-2910
Fax Number : 919-639-3079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2016
Last Update Date : 04/19/2016

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