Provider Demographics
NPI:1639352172
Name:ROBILLARD, MCKENZIE MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MCKENZIE
Middle Name:MARIE
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:MCKENZIE
Other - Middle Name:M
Other - Last Name:SCHARF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12011
Mailing Address - Country:US
Mailing Address - Phone:518-783-9440
Mailing Address - Fax:518-785-4290
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:SUITE C100
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-352-8548
Practice Address - Fax:516-352-8564
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist