Provider Demographics
NPI:1164150355
Name:STANNARD, MCKENZIE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:L
Last Name:STANNARD
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 1:1 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6232
Mailing Address - Country:US
Mailing Address - Phone:802-651-1449
Mailing Address - Fax:
Practice Address - Street 1:1 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6232
Practice Address - Country:US
Practice Address - Phone:802-651-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist