Provider Demographics
NPI:1922389394
Name:MCCARTY, KELLY L (DPHARM)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:DPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 BLAKE WILBUR DR
Mailing Address - Street 2:SUITE CC1101
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2205
Mailing Address - Country:US
Mailing Address - Phone:650-838-0429
Mailing Address - Fax:650-838-0447
Practice Address - Street 1:875 BLAKE WILBUR DR
Practice Address - Street 2:SUITE CC1101
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-838-0429
Practice Address - Fax:650-838-0447
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419741835X0200X
OK106011835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology