Provider Demographics
NPI:1245930742
Name:MCNEW, MAKAYLA KENNEDY
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:KENNEDY
Last Name:MCNEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EARL HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:KEAVY
Mailing Address - State:KY
Mailing Address - Zip Code:40737-2618
Mailing Address - Country:US
Mailing Address - Phone:606-312-2750
Mailing Address - Fax:
Practice Address - Street 1:610 EARL HOWARD RD
Practice Address - Street 2:
Practice Address - City:KEAVY
Practice Address - State:KY
Practice Address - Zip Code:40737-2618
Practice Address - Country:US
Practice Address - Phone:606-312-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0222161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY022216OtherKENTUCKY BOARD OF PHARMACY
KYM11-211-091OtherSTATE OF KENTUCKY