Provider Demographics
NPI:1326354861
Name:MCKINNEY, EDNA WASHINGTON
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:WASHINGTON
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N FAYETTEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5529
Mailing Address - Country:US
Mailing Address - Phone:336-633-7611
Mailing Address - Fax:336-633-7608
Practice Address - Street 1:207 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5529
Practice Address - Country:US
Practice Address - Phone:336-633-7611
Practice Address - Fax:336-633-7608
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist