Provider Demographics
NPI:1912050907
Name:MCKAY FAMILY PHARMACY
Entity Type:Organization
Organization Name:MCKAY FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-829-4821
Mailing Address - Street 1:305 E MORGAN ST
Mailing Address - Street 2:P.O. BOX 553
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1429
Mailing Address - Country:US
Mailing Address - Phone:812-829-4821
Mailing Address - Fax:812-829-0882
Practice Address - Street 1:305 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1429
Practice Address - Country:US
Practice Address - Phone:812-829-4821
Practice Address - Fax:812-829-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60002998A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0640940001Medicare ID - Type Unspecified