Provider Demographics
NPI:1538771365
Name:MCKINLEY, WADE (PHARMD)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHERRYWOOD PL STE 100
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8927
Mailing Address - Country:US
Mailing Address - Phone:502-465-5500
Mailing Address - Fax:502-465-5600
Practice Address - Street 1:1000 CHERRYWOOD PL STE 100
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8927
Practice Address - Country:US
Practice Address - Phone:502-465-5500
Practice Address - Fax:502-465-5600
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist