Provider Demographics
NPI:1992093595
Name:SKEESE, JOHNNY R III (RPH)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:R
Last Name:SKEESE
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S HIGHWAY 127
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4559
Mailing Address - Country:US
Mailing Address - Phone:270-866-7166
Mailing Address - Fax:270-866-9332
Practice Address - Street 1:301 S HIGHWAY 127
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4559
Practice Address - Country:US
Practice Address - Phone:270-866-7166
Practice Address - Fax:270-866-9332
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist