Provider Demographics
NPI:1255979845
Name:MCCULLOCH, ALICE E (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:E
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 LACEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9478
Mailing Address - Country:US
Mailing Address - Phone:502-641-0695
Mailing Address - Fax:
Practice Address - Street 1:2864 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-1978
Practice Address - Country:US
Practice Address - Phone:812-948-0953
Practice Address - Fax:812-948-1368
Is Sole Proprietor?:No
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0142951835P0018X
TN333491835P0018X
IN26020885A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist