Provider Demographics
NPI:1093919599
Name:MCQUEEN, MALIEA S (RPH)
Entity Type:Individual
Prefix:
First Name:MALIEA
Middle Name:S
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-7663
Mailing Address - Country:US
Mailing Address - Phone:606-723-4060
Mailing Address - Fax:606-723-0642
Practice Address - Street 1:110 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7222
Practice Address - Country:US
Practice Address - Phone:606-723-2146
Practice Address - Fax:606-723-0642
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist