Organization
MIKELS DRIVE IN PHARMACY INC
Active
Other names
Fountain Square Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE MCGLONE (PHARMD)
(606) 248-1052
Entity
Organization
Contact information
Practice address
1928 CUMBERLAND AVE, MIDDLESBORO, KY 40965-1231
(606) 248-1052
(606) 248-6598
Mailing address
1928 CUMBERLAND AVE, MIDDLESBORO, KY 40965-1231
(606) 248-1052
(606) 248-6598
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P07708
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153658
PK
—
05
—
4582114
—
TN
05
—
54011945
—
KY
Enumeration date
07/19/2005
Last updated
06/28/2016
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