Provider Demographics
NPI:1114220027
Name:FLETCHER, KEVIN GORDON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GORDON
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 MERRIMON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2405
Mailing Address - Country:US
Mailing Address - Phone:828-252-1866
Mailing Address - Fax:828-250-0974
Practice Address - Street 1:846 MERRIMON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2405
Practice Address - Country:US
Practice Address - Phone:828-252-1866
Practice Address - Fax:828-250-0974
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist