MEDICARE: GREGORY PELKEY

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	246RM2200X	Medical Laboratory Technician	245310	IL

General Provider Information

NPI Number	:	1710345186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY PELKEY

Provider Business Mailing Address
First Line	:	1010 FIALL ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6130
Country	:	US
Telephone Number	:	269-519-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 FIALL ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6130
Country	:	US
Telephone Number	:	269-519-0262
Fax Number	:

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	02/01/2016

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