Provider Demographics
NPI:1598364796
Name:O'SHEA, MACKENZIE RYANN BROGLIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:RYANN BROGLIE
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:RYANN
Other - Last Name:JUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 HENLEY CT APT E
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4967
Mailing Address - Country:US
Mailing Address - Phone:757-945-8455
Mailing Address - Fax:
Practice Address - Street 1:919 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4322
Practice Address - Country:US
Practice Address - Phone:757-827-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist