Healthcare Provider Details

I. General information

NPI: 1043205263
Provider Name (Legal Business Name): KENNETH L MCCALL III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S COULTER ST OFFICE 321
AMARILLO TX
79106-1712
US

IV. Provider business mailing address

1300 S COULTER ST OFFICE 321
AMARILLO TX
79106-1712
US

V. Phone/Fax

Practice location:
  • Phone: 806-356-4000
  • Fax: 806-356-4018
Mailing address:
  • Phone: 806-356-4000
  • Fax: 806-356-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number37517
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: