Provider Demographics
NPI:1952904898
Name:MINCHEW, KALIE JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:JEAN
Last Name:MINCHEW
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 1:1328 CLIFFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-5919
Mailing Address - Country:US
Mailing Address - Phone:912-282-7748
Mailing Address - Fax:
Practice Address - Street 1:1630 PLANT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5247
Practice Address - Country:US
Practice Address - Phone:912-584-6084
Practice Address - Fax:912-684-6083
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist