Provider Demographics
NPI:1396020970
Name:RATLIFF, KACIE ELLEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:ELLEN
Last Name:RATLIFF
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 1:6910 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1229
Mailing Address - Country:US
Mailing Address - Phone:601-956-3844
Mailing Address - Fax:601-956-5493
Practice Address - Street 1:6910 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1229
Practice Address - Country:US
Practice Address - Phone:601-956-3844
Practice Address - Fax:601-956-5493
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist