Provider Demographics
NPI:1952517849
Name:MCQUEEN, BOBBY CLAYTON (RPH)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:CLAYTON
Last Name:MCQUEEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 50 B
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-9409
Mailing Address - Country:US
Mailing Address - Phone:606-593-7133
Mailing Address - Fax:606-464-9002
Practice Address - Street 1:111 RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311
Practice Address - Country:US
Practice Address - Phone:606-464-3656
Practice Address - Fax:606-464-9002
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist