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General NPI Number Information
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NPI Number | 1336426329
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Entity Type | Individual
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Provider Name | KEVIN J MCCULLOUGH RPH
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Gender | Male
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 555 S SUNRISE WAY SUITE 112-113
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City | PALM SPRINGS
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State | CA
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Zip | 92264-7869
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Country | US
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Telephone | 760-323-1973
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Fax | 760-320-5236
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Provider Business Mailing Address
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Address Line | 555 S SUNRISE WAY SUITE 112-113
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City | PALM SPRINGS
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State | CA
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Zip | 92264-7869
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Country | US
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Telephone | 760-323-1973
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Fax | 760-320-5236
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 54549
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License Number State | CA
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