Provider Demographics
NPI:1467554105
Name:MCKENNY, CAROL H (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:H
Last Name:MCKENNY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-5403
Mailing Address - Country:US
Mailing Address - Phone:334-445-9767
Mailing Address - Fax:334-793-3691
Practice Address - Street 1:3850 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1045
Practice Address - Country:US
Practice Address - Phone:334-794-6112
Practice Address - Fax:334-793-3691
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10291183500000X
FL21250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist