Provider Demographics
NPI:1437749579
Name:MEADOR, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MEADOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-9602
Mailing Address - Country:US
Mailing Address - Phone:270-237-4446
Mailing Address - Fax:270-237-7782
Practice Address - Street 1:1088 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-9602
Practice Address - Country:US
Practice Address - Phone:270-237-4446
Practice Address - Fax:270-237-7782
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0099011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist