Provider Demographics
NPI:1508249970
Name:DACRE, MACKENZIE LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:LEE
Last Name:DACRE
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 1:132 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5060
Mailing Address - Country:US
Mailing Address - Phone:617-479-2330
Mailing Address - Fax:617-479-2601
Practice Address - Street 1:132 GRANITE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5060
Practice Address - Country:US
Practice Address - Phone:617-479-2330
Practice Address - Fax:617-479-2601
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist