Provider Demographics
NPI:1306006598
Name:MCCORMICK, ANDREW SPENCER (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SPENCER
Last Name:MCCORMICK
Suffix:
Gender:M
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40755-0190
Mailing Address - Country:US
Mailing Address - Phone:606-864-2600
Mailing Address - Fax:
Practice Address - Street 1:731 N LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6025
Practice Address - Country:US
Practice Address - Phone:606-864-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist