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General NPI Number Information
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NPI Number | 1225197445
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Entity Type | Individual
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Provider Name | KENNETH E MCCULLOUGH PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 112 E MAIN ST
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City | POMEROY
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State | OH
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Zip | 45769
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Country | US
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Telephone | 740-992-5322
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Fax | 740-992-5244
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Provider Business Mailing Address
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Address Line | 235 MULBERRY AVE
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City | POMEROY
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State | OH
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Zip | 45769
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Country | US
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Telephone | 740-992-5322
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Fax | 740-992-5244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03108295
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License Number State | OH
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