Provider Demographics
NPI:1598045635
Name:MACKEY, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6271 CAROLINA COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5980
Mailing Address - Country:US
Mailing Address - Phone:803-802-5400
Mailing Address - Fax:803-548-9355
Practice Address - Street 1:6271 CAROLINA COMMONS DR
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-5980
Practice Address - Country:US
Practice Address - Phone:803-802-5400
Practice Address - Fax:803-548-9355
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist