Healthcare Provider Details

I. General information

NPI: 1730152901
Provider Name (Legal Business Name): MATT W MCKEE RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E GRAND AVE
MEMPHIS MO
63555-1562
US

IV. Provider business mailing address

RR 1 BOX 94M
MEMPHIS MO
63555-9801
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-2400
  • Fax: 660-465-2600
Mailing address:
  • Phone: 660-945-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2004028311
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: