Provider Demographics
NPI:1912681503
Name:HARRELL, MCKENNA ELIZABETH
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:ELIZABETH
Last Name:HARRELL
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 1:7811 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2656
Mailing Address - Country:US
Mailing Address - Phone:317-544-9754
Mailing Address - Fax:
Practice Address - Street 1:7811 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2656
Practice Address - Country:US
Practice Address - Phone:317-544-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027671A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist