Provider Demographics
NPI:1346861853
Name:MCGRAW, MACKENZIE MAE (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:MACKENZIE
Middle Name:MAE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MURPHY LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13811-4752
Mailing Address - Country:US
Mailing Address - Phone:607-778-9557
Mailing Address - Fax:
Practice Address - Street 1:177 ERIE BLVD
Practice Address - Street 2:
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-2791
Practice Address - Country:US
Practice Address - Phone:570-853-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30032403183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
30032403OtherPHARMACY TECHNICIAN CERTIFICATION BOARD