Provider Demographics
NPI:1710479241
Name:MCCAYS TOTAL CARE PHARMACY SOUTH LLC
Entity Type:Organization
Organization Name:MCCAYS TOTAL CARE PHARMACY SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTROBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-316-2031
Mailing Address - Street 1:852 RIDGEWOOD DRIVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:852 RIDGEWOOD DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403
Practice Address - Country:US
Practice Address - Phone:859-749-1883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy