Provider Demographics
NPI:1952836348
Name:MCGOUGH, KACEY (RPH,, PHARMD)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:RPH,, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1298
Mailing Address - Country:US
Mailing Address - Phone:614-876-1248
Mailing Address - Fax:
Practice Address - Street 1:4656 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1298
Practice Address - Country:US
Practice Address - Phone:614-876-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist