Healthcare Provider Details

I. General information

NPI: 1811443435
Provider Name (Legal Business Name): MARCUS E. MCKINNEY PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 DONNERMEYER DR
BELLEVUE KY
41073-1352
US

IV. Provider business mailing address

53 DONNERMEYER DR
BELLEVUE KY
41073-1352
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-5413
  • Fax: 859-491-0302
Mailing address:
  • Phone: 859-431-5413
  • Fax: 859-491-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number018802
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: