Individual
DR. KENNETH RAY FLY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
4539 TEAYS VALLEY RD, SCOTT DEPOT, WV 25560-7806
(304) 201-1630
Mailing address
2371 VIRGINIA AVE, HURRICANE, WV 25526-1067
(681) 427-5708
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0010499
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP0010499
PHARMACIST LICENSE
WV
Enumeration date
10/11/2018
Last updated
10/11/2018
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