Provider Demographics
NPI:1831439330
Name:MCMINN, JAMES LEONARD (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEONARD
Last Name:MCMINN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 SUE LN
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-2045
Mailing Address - Country:US
Mailing Address - Phone:620-331-4181
Mailing Address - Fax:
Practice Address - Street 1:208 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1462
Practice Address - Country:US
Practice Address - Phone:620-879-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist