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General NPI Number Information
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NPI Number | 1558649632
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Entity Type | Individual
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Provider Name | JACK MICHAEL MCGUIRE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2011
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Last Update Date | 07/24/2011
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Provider Practice Location Address
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Address Line | 4174 WESTPORT RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-2735
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Country | US
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Telephone | 502-992-1039
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Fax |
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Provider Business Mailing Address
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Address Line | 904 FENLEY AVE
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City | LOUISVILLE
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State | KY
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Zip | 40222-4448
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Country | US
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Telephone | 502-412-2899
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 015606
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License Number State | KY
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