Provider Demographics
NPI:1043859945
Name:MCKEE FAMILY PHARMACY LLC
Entity type:Organization
Organization Name:MCKEE FAMILY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-813-0603
Mailing Address - Street 1:565 MAIN STREET N
Mailing Address - Street 2:
Mailing Address - City:MCKEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:565 MAIN STREET N
Practice Address - Street 2:
Practice Address - City:MCKEE
Practice Address - State:KY
Practice Address - Zip Code:40447
Practice Address - Country:US
Practice Address - Phone:606-813-0603
Practice Address - Fax:888-900-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100641490Medicaid