Provider Demographics
NPI:1275818627
Name:MCCRARY, KASEY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:L
Last Name:MCCRARY
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 1:5917 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-5046
Mailing Address - Country:US
Mailing Address - Phone:501-565-7844
Mailing Address - Fax:501-565-0463
Practice Address - Street 1:5917 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-5046
Practice Address - Country:US
Practice Address - Phone:501-565-7844
Practice Address - Fax:501-565-0463
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12155183500000X
AR11003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist