Healthcare Provider Details

I. General information

NPI: 1922196732
Provider Name (Legal Business Name): KATHY COLLINS MCNEILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 VETERANS MEMORIAL HWY
REEDSVILLE WV
26547
US

IV. Provider business mailing address

PO BOX 205
REEDSVILLE WV
26547-0205
US

V. Phone/Fax

Practice location:
  • Phone: 304-864-6935
  • Fax: 304-864-3910
Mailing address:
  • Phone: 304-864-6935
  • Fax: 304-864-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0550748
License Number StateWV

VIII. Authorized Official

Name: KATHY MCNEILL
Title or Position: OWNER
Credential:
Phone: 304-864-6935