MIKELS DRIVE IN PHARMACY INC NPI 1700885001

NPI Information

  • NPI: 1700885001
  • Provider Name: MIKELS DRIVE IN PHARMACY INC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: FOUNTAIN SQUARE PHARMACY
  • CLIA Number: 18D2296964
  • Address: 1928 CUMBERLAND AVE
    MIDDLESBORO, KY
    ZIP 40965
  • Phone: (606) 248-1052

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NPI Details

MIKELS DRIVE IN PHARMACY INC is a community/retail pharmacy pharmacy in Middlesboro, KY. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. MIKELS DRIVE IN PHARMACY INC NPI is 1700885001. The provider is registered as an organization entity type.
The provider Is Doing Business As Fountain Square Pharmacy.

The provider's business location address is:

1928 CUMBERLAND AVE
MIDDLESBORO, KY
ZIP 40965-231
Phone: (606) 248-1052
Fax: (606) 248-6598

The provider's authorized official is Maurice Mcglone .
The authorized official title is Pharmd and has the following contact phone number (606) 248-1052.

The CLIA number assigned to this NPI record is 18D2296964 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/19/2005 and was last updated on 6/28/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
23336C0003XPharmacyCommunity/Retail PharmacyP07708KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
154011945MEDICAIDKENTUCKY
24582114MEDICAIDTENNESSEE
32153658OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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