Provider Demographics
NPI:1689912776
Name:MACKEY, NICKEY L (DP)
Entity Type:Individual
Prefix:
First Name:NICKEY
Middle Name:L
Last Name:MACKEY
Suffix:
Gender:M
Credentials:DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4119
Mailing Address - Country:US
Mailing Address - Phone:615-494-3392
Mailing Address - Fax:615-494-3487
Practice Address - Street 1:4175 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4119
Practice Address - Country:US
Practice Address - Phone:615-494-3392
Practice Address - Fax:615-494-3487
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist