Provider Demographics
NPI:1376752220
Name:STINNETT, MICHAEL E (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:STINNETT
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 1884
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1884
Mailing Address - Country:US
Mailing Address - Phone:270-392-4248
Mailing Address - Fax:
Practice Address - Street 1:705 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1628
Practice Address - Country:US
Practice Address - Phone:270-842-4515
Practice Address - Fax:270-901-0187
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist