Provider Demographics
NPI:1710243191
Name:ABBOTT, MCKINZEE A (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:MCKINZEE
Middle Name:A
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0407
Mailing Address - Country:US
Mailing Address - Phone:800-546-5677
Mailing Address - Fax:866-632-7946
Practice Address - Street 1:13660 CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:800-546-5677
Practice Address - Fax:866-632-7946
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2014-10-20
Deactivation Date:2014-08-15
Deactivation Code:
Reactivation Date:2014-10-20
Provider Licenses
StateLicense IDTaxonomies
NE480183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4901-0701-0031-564OtherCERTIFICATION NUMBER
NE480OtherSTATE LICENSE