Justin Douglas McKinnie

Primary specialty

PharmacistTaxonomy code 183500000X

License

051292076 Issued in IL

Practice address

101 Dettro Dr
Mattoon, IL 61938-9044

Phone

(217) 258-6313

NPI assigned

Nov 16, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1154923084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9854 N COUNTY ROAD 000E",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619386505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DETTRO DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389044",
            "telephone_number": "217-258-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNIE",
        "first_name": "JUSTIN",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051292076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary H McGuire, APN,BC
• Laura McHenry, BS
• David McIntyre, BA
• James Keith McKechnie, M.D.
• Gabe E McKibben
• Paula C McNitt, PHD
• Elizabeth McQueen, B.A.
• Haley McQueen, DPT
• MDT Holistic Healing and Counseling
• Louis B Mendella, DO

• Pharmacist in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.