Provider Demographics
NPI:1225608227
Name:COLMIRE, MIKALA BROOKE MCATEE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MIKALA
Middle Name:BROOKE MCATEE
Last Name:COLMIRE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 GARVEY RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:KY
Mailing Address - Zip Code:41006-7504
Mailing Address - Country:US
Mailing Address - Phone:859-445-1425
Mailing Address - Fax:
Practice Address - Street 1:6617 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2164
Practice Address - Country:US
Practice Address - Phone:859-445-1425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022032183500000X
OH03440583183500000X
KY022032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist