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General NPI Number Information
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NPI Number | 1700885001
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Entity Type | Organization
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Legal Business Name | MIKELS DRIVE IN PHARMACY INC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 1928 CUMBERLAND AVE
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1231
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Country | US
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Telephone | 606-248-1052
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Fax | 606-248-6598
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Provider Business Mailing Address
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Address Line | 1928 CUMBERLAND AVE
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1231
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Country | US
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Telephone | 606-248-1052
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Fax | 606-248-6598
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Authorized Official
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Title or Position | PHARMD
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Name | MAURICE MCGLONE
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Credential |
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Telephone | 606-248-1052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07708
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License Number State | KY
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