Provider Demographics
NPI:1609007632
Name:MCCARTY, KELLI BASS (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:BASS
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-1303
Mailing Address - Country:US
Mailing Address - Phone:706-342-4141
Mailing Address - Fax:706-342-3297
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-1303
Practice Address - Country:US
Practice Address - Phone:706-342-4141
Practice Address - Fax:706-342-3297
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH-022020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist