Individual provider Active NPI

Kalie Jean Minchew, PHARMD

  • Pharmacist
  • Waycross, GA
National Provider Identifier
1952904898
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH028330 Issued in GA
Practice address
1630 Plant Ave
Waycross, GA 31501-5247
Phone
(912) 584-6084
Fax
(912) 684-6083
NPI assigned
Nov 20, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH028330 GA Primary

Addresses

Primary practice location

1630 Plant Ave
Waycross, GA 31501-5247

Mailing address

1328 Clifford Loop
Blackshear, GA 31516-5919
Phone (912) 282-7748

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RPH028330GAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1952904898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1328 CLIFFORD LOOP",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315165919",
            "telephone_number": "912-282-7748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 PLANT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015247",
            "telephone_number": "912-584-6084",
            "fax_number": "912-684-6083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINCHEW",
        "first_name": "KALIE",
        "middle_name": "JEAN",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH028330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.