Kenneth Ray Fly II, PHARMD
Individual provider Active NPI Pharmacist · Scott Depot, WV
NPI 1427523976 · NPPES record last updated Oct 11, 2018
Key facts
- NPI
- 1427523976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP0010499 (WV)
- Practice address
- 4539 Teays Valley Rd
Scott Depot, WV 25560-7806 - Phone
- (304) 201-1630
- NPI assigned
- Oct 11, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP0010499 | WV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fruth Pharmacy Inc | Past | Accepting new patients | |
| Fruth Pharmacy Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP0010499 | WV | Yes |
Addresses
Primary practice location
4539 Teays Valley Rd
Scott Depot, WV 25560-7806
Mailing address
2371 Virginia Ave
Hurricane, WV 25526-1067
Phone (681) 427-5708
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RP0010499 | Other | WV | PHARMACIST LICENSE |
Other providers in Scott Depot, WV
- Envirocair, Inc
- Allison Farley
- Angela Beth Ferguson
- Lucy Fielder
- Tanna E Finney
- Sarah Foster
- Jan Byrnside Frame
- Kimberly Jean Frame
- Jody Joe Franco
- Emily Alison Frazier
All providers in Scott Depot, WV · Pharmacist in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.