Provider Demographics
NPI:1376828335
Name:MACKENZIE, JUSTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 US HIGHWAY 93 S
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2959
Mailing Address - Country:US
Mailing Address - Phone:406-862-2526
Mailing Address - Fax:406-862-6294
Practice Address - Street 1:6580 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2959
Practice Address - Country:US
Practice Address - Phone:406-862-2526
Practice Address - Fax:406-862-6294
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3990OtherMT PHARMACIST LICENSE #