Provider Demographics
NPI:1558652685
Name:MCKENNEY, PATRICK J (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:MCKENNEY
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 1:602 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8658
Mailing Address - Country:US
Mailing Address - Phone:810-735-1341
Mailing Address - Fax:810-935-1491
Practice Address - Street 1:602 W BROAD ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8658
Practice Address - Country:US
Practice Address - Phone:810-735-1341
Practice Address - Fax:810-935-1491
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist