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General NPI Number Information
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NPI Number | 1407254139
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Entity Type | Organization
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Legal Business Name | MCKMAN II LLC
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 2274 N US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34946-8914
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Country | US
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Telephone | 772-333-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 2274 N US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34946-8914
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Country | US
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Telephone | 772-333-2199
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | THOMAS BENEDETTO
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Credential |
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Telephone | 772-333-2199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | OS9102
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License Number State | FL
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