Provider Demographics
NPI:1700218716
Name:MCGINESS, MALLORY RAE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:RAE
Last Name:MCGINESS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:MALLORY
Other - Middle Name:RAE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10109 OAK CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1630
Mailing Address - Country:US
Mailing Address - Phone:518-578-1296
Mailing Address - Fax:
Practice Address - Street 1:1415 OLD WEISGARBER RD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1341
Practice Address - Country:US
Practice Address - Phone:865-934-5806
Practice Address - Fax:865-934-5816
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38315183500000X
PARP449945183500000X
VT033.0096154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist