Provider Demographics
NPI:1235191339
Name:MCKEE MEDICAL PHARMACY INC
Entity Type:Organization
Organization Name:MCKEE MEDICAL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-923-8871
Mailing Address - Street 1:2350 MCKEE RD
Mailing Address - Street 2:STE A3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1617
Mailing Address - Country:US
Mailing Address - Phone:408-923-8871
Mailing Address - Fax:408-259-4416
Practice Address - Street 1:2350 MCKEE RD
Practice Address - Street 2:STE A3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1617
Practice Address - Country:US
Practice Address - Phone:408-923-8871
Practice Address - Fax:408-259-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY40638333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA406380Medicaid
CA0838860001Medicare NSC