Provider Demographics
NPI:1619290533
Name:MACKEY, JAMES OTIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:OTIS
Last Name:MACKEY
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 1:3020 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5323
Mailing Address - Country:US
Mailing Address - Phone:719-473-3822
Mailing Address - Fax:719-473-0380
Practice Address - Street 1:3020 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5323
Practice Address - Country:US
Practice Address - Phone:719-473-3822
Practice Address - Fax:719-473-0380
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10268183500000X
TX19781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist