Provider Demographics
NPI:1558675983
Name:MCKIE, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:MCKIE
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 1:1305 141ST ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-8128
Mailing Address - Country:US
Mailing Address - Phone:515-465-5484
Mailing Address - Fax:515-465-5488
Practice Address - Street 1:1305 141ST ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-8128
Practice Address - Country:US
Practice Address - Phone:515-465-5484
Practice Address - Fax:515-465-5488
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist