Individual
JUSTIN DOUGLAS MCKINNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 DETTRO DR, MATTOON, IL 61938-9044
(217) 258-6313
Mailing address
9854 N COUNTY ROAD 000E, MATTOON, IL 61938-6505
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051292076
IL
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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