Provider Demographics
NPI:1225260318
Name:MCKINNEY, BARBARA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUE
Last Name:MCKINNEY
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 1:426 PAGOSA ST
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-264-4166
Mailing Address - Fax:
Practice Address - Street 1:426 PAGOSO STREET
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-246-4166
Practice Address - Fax:970-264-3289
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005756183500000X
HIPH 2719183500000X
COPHA18641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1629043971Medicaid
CO1871658922OtherNPI