Provider Demographics
NPI:1992875553
Name:MCKEE, PHYLLIS A (RPH)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:A
Last Name:MCKEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TRAER
Mailing Address - State:IA
Mailing Address - Zip Code:50675-9374
Mailing Address - Country:US
Mailing Address - Phone:319-478-2055
Mailing Address - Fax:
Practice Address - Street 1:500 2ND ST
Practice Address - Street 2:
Practice Address - City:TRAER
Practice Address - State:IA
Practice Address - Zip Code:50675-1139
Practice Address - Country:US
Practice Address - Phone:319-478-8711
Practice Address - Fax:319-478-2501
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist