Provider Demographics
NPI:1083269476
Name:MCKINNEY, JARED (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N HIGHLAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-8568
Mailing Address - Country:US
Mailing Address - Phone:828-692-0546
Mailing Address - Fax:
Practice Address - Street 1:220 N HIGHLAND LAKE RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-8568
Practice Address - Country:US
Practice Address - Phone:828-692-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist