Provider Demographics
NPI:1891087482
Name:MCCRARY, AMY KATHRYN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHRYN
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLYNN ISLE
Mailing Address - Street 2:TARGET PHARMACY T2301
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-2929
Mailing Address - Country:US
Mailing Address - Phone:912-261-4869
Mailing Address - Fax:912-261-4879
Practice Address - Street 1:200 GLYNN ISLE
Practice Address - Street 2:TARGET PHARMACY T2301
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-2929
Practice Address - Country:US
Practice Address - Phone:912-261-4869
Practice Address - Fax:912-261-4879
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022295183500000X
NE10634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist