Provider Demographics
NPI:1679605240
Name:MCNIEL, JOHN TIPTON JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TIPTON
Last Name:MCNIEL
Suffix:JR
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:PO BOX 1443
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-1443
Mailing Address - Country:US
Mailing Address - Phone:606-573-6150
Mailing Address - Fax:
Practice Address - Street 1:2478 S US HIGHWAY 421
Practice Address - Street 2:WOODLAND PLAZA
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-1727
Practice Address - Country:US
Practice Address - Phone:606-573-7200
Practice Address - Fax:606-574-0406
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist