NPIMap

Organization Active NPI

Mikels Drive in Pharmacy Inc

Doing business as Fountain Square Pharmacy

  • Community/Retail Pharmacy
  • Middlesboro, KY
National Provider Identifier
1700885001
Registry record updated Jun 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P07708 Issued in KY
Legal business name
MIKELS DRIVE IN PHARMACY INC
Doing business as
Fountain Square Pharmacy
Practice address
1928 Cumberland Ave
Middlesboro, KY 40965-1231
Phone
(606) 248-1052
Fax
(606) 248-6598
NPI assigned
Jul 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2016

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

Authorized official

Name
Maurice McGlone
Title
Pharmd
Phone
(606) 248-1052

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X P07708 KY Primary

Addresses

Primary practice location

1928 Cumberland Ave
Middlesboro, KY 40965-1231

Mailing address

1928 Cumberland Ave
Middlesboro, KY 40965-1231
Phone (606) 248-1052

Other identifiers 3

IdentifierTypeStateIssuer
2153658OtherPK
54011945MedicaidKY
4582114MedicaidTN

Other names 1

  • Fountain Square Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mikels Drive in Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1700885001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1928 CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409651231",
            "telephone_number": "606-248-1052",
            "fax_number": "606-248-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1928 CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409651231",
            "telephone_number": "606-248-1052",
            "fax_number": "606-248-6598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKELS DRIVE IN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2016-06-28",
        "status": "A",
        "authorized_official_last_name": "MCGLONE",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_title_or_position": "PHARMD",
        "authorized_official_telephone_number": "606-248-1052"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153658",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54011945",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4582114",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Square Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Middlesboro, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.