Provider Demographics
NPI:1396036844
Name:COX MAYNARD, ALISON TEGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:TEGAN
Last Name:COX MAYNARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 CARDINAL ESTS
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-8881
Mailing Address - Country:US
Mailing Address - Phone:606-534-7340
Mailing Address - Fax:
Practice Address - Street 1:200 ROCKCASTLE ROAD
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-8881
Practice Address - Country:US
Practice Address - Phone:606-298-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012966183500000X
WVRP0006797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist