Provider Demographics
NPI:1821684341
Name:RAINEY, KACI MICHELLE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:KACI
Middle Name:MICHELLE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:MICHELLE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1503
Mailing Address - Country:US
Mailing Address - Phone:864-439-1040
Mailing Address - Fax:864-949-0461
Practice Address - Street 1:101 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1503
Practice Address - Country:US
Practice Address - Phone:864-439-1040
Practice Address - Fax:864-949-0461
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20515183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20515OtherSC BOP