Provider Demographics
NPI:1003081621
Name:BLACKERBY, KACEY KEGANS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KACEY
Middle Name:KEGANS
Last Name:BLACKERBY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-1229
Mailing Address - Country:US
Mailing Address - Phone:903-587-3363
Mailing Address - Fax:903-587-2714
Practice Address - Street 1:122 W. COLLIN ST.
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452
Practice Address - Country:US
Practice Address - Phone:903-587-3363
Practice Address - Fax:903-587-2714
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist