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General NPI Number Information
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NPI Number | 1497196828
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Entity Type | Individual
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Provider Name | MR. MONTEGO MCKINNON SR.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 1501 PASADENA SHORES DR
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City | ST. PETERSBURG
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State | FL
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Zip | 33707
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Country | US
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Telephone | 727-341-7856
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 6TH ST S #203
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City | ST PETERSBURG
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State | FL
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Zip | 33705-7710
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Country | US
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Telephone | 727-417-7652
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Fax |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | RPT 41368
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License Number State | FL
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