Provider Demographics
NPI:1518188028
Name:OWENSBY, RICHARD KELLY III
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KELLY
Last Name:OWENSBY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3711
Mailing Address - Country:US
Mailing Address - Phone:828-433-8192
Mailing Address - Fax:
Practice Address - Street 1:200 W FLEMING DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3918
Practice Address - Country:US
Practice Address - Phone:828-433-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist