Provider Demographics
NPI:1598008047
Name:MCKENZIE, JOHN RODRICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RODRICK
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5452 HAVENHURST CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4450
Mailing Address - Country:US
Mailing Address - Phone:916-749-9699
Mailing Address - Fax:
Practice Address - Street 1:5452 HAVENHURST CIR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4450
Practice Address - Country:US
Practice Address - Phone:916-749-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist