Provider Demographics
NPI:1639481609
Name:MCKENZIE, MARVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:MCKENZIE
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 1:1332 NORTH HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4019
Mailing Address - Country:US
Mailing Address - Phone:731-427-4992
Mailing Address - Fax:731-427-2456
Practice Address - Street 1:1332 NORTH HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4019
Practice Address - Country:US
Practice Address - Phone:731-427-4992
Practice Address - Fax:731-427-2456
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist