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General NPI Number Information
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NPI Number | 1710479241
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Entity Type | Organization
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Legal Business Name | MCCAYS TOTAL CARE PHARMACY SOUTH LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 852 RIDGEWOOD DRIVE SUITE F
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City | BEREA
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State | KY
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Zip | 40403
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Country | US
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Telephone | 859-749-1883
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Fax |
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Provider Business Mailing Address
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Address Line | 852 RIDGEWOOD DRIVE SUITE F
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City | BEREA
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State | KY
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Zip | 40403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | WANDA ANTROBUS
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Credential |
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Telephone | 606-316-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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