Provider Demographics
NPI:1891203816
Name:VOLMY, MACKENZY COLTON
Entity Type:Individual
Prefix:
First Name:MACKENZY
Middle Name:COLTON
Last Name:VOLMY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 SHALIMAR ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2559
Mailing Address - Country:US
Mailing Address - Phone:850-502-7093
Mailing Address - Fax:
Practice Address - Street 1:600 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6731
Practice Address - Country:US
Practice Address - Phone:954-433-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist