Provider Demographics
NPI:1023399037
Name:MCKENNA, JOHN J III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:MCKENNA
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 1:3625 WRANGLE HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701
Mailing Address - Country:US
Mailing Address - Phone:302-353-1050
Mailing Address - Fax:302-543-2413
Practice Address - Street 1:3625 WRANGLE HILL ROAD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701
Practice Address - Country:US
Practice Address - Phone:302-353-1050
Practice Address - Fax:302-543-2413
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003241183500000X
PARP042578L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist