Provider Demographics
NPI:1083804645
Name:MCKENZIE, KRISTINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10764 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1016
Mailing Address - Country:US
Mailing Address - Phone:330-527-2828
Mailing Address - Fax:
Practice Address - Street 1:10764 NORTH ST
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-1016
Practice Address - Country:US
Practice Address - Phone:330-527-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist