Provider Demographics
NPI:1205127768
Name:MCKENNA, JOHN PATRICK (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:MCKENNA
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 1:1600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1259
Mailing Address - Country:US
Mailing Address - Phone:304-527-4082
Mailing Address - Fax:304-527-1907
Practice Address - Street 1:1600 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1259
Practice Address - Country:US
Practice Address - Phone:304-527-4082
Practice Address - Fax:304-527-1907
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5979183500000X
OH03322133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist