MEDICARE: JOHNNY R SKEESE III RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	011433	KY

General Provider Information

NPI Number	:	1992093595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY R SKEESE III RPH

Provider Business Mailing Address
First Line	:	301 S HIGHWAY 127
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-4559
Country	:	US
Telephone Number	:	270-866-7166
Fax Number	:	270-866-9332

Provider Business Practice Location Address
First Line	:	301 S HIGHWAY 127
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-4559
Country	:	US
Telephone Number	:	270-866-7166
Fax Number	:	270-866-9332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2011
Last Update Date	:	07/16/2011

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