Provider Demographics
NPI:1699972125
Name:MCDOWELL PROFESSIONAL PHARMACY INC.
Entity type:Organization
Organization Name:MCDOWELL PROFESSIONAL PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-377-1088
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:9549 KY RT 122
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0700
Mailing Address - Country:US
Mailing Address - Phone:606-377-1088
Mailing Address - Fax:
Practice Address - Street 1:9549 KY RT 122
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-0700
Practice Address - Country:US
Practice Address - Phone:606-377-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90210360332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90210360Medicaid