MEDICARE: MICHAEL RICHARD MCKINNEY R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH012029	GA

General Provider Information

NPI Number	:	1225406374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RICHARD MCKINNEY R.PH.

Provider Business Mailing Address
First Line	:	3347 MUSCADINE TRL NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5020
Country	:	US
Telephone Number	:	770-974-8713
Fax Number	:

Provider Business Practice Location Address
First Line	:	3513 BAKER RD NW
Second Line	:	SUITE 500
City	:	ACWORTH
State	:	GA
Zip	:	30101-3706
Country	:	US
Telephone Number	:	770-917-0408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2015
Last Update Date	:	09/07/2015

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