1245968494 NPI number — DR. KELSEY RAE FLUHARTY PHARMD

Table of content: DR. KELSEY RAE FLUHARTY PHARMD (NPI 1245968494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245968494 NPI number — DR. KELSEY RAE FLUHARTY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLUHARTY
Provider First Name:
KELSEY
Provider Middle Name:
RAE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASH
Provider Other First Name:
KELSEY
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245968494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6047 VERMILION LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANITEVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29829-3259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-689-4770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6047 VERMILION LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANITEVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29829-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-689-4770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH032915 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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