Provider Demographics
NPI:1891398491
Name:MACKEY, ANDRE CARNEGIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:CARNEGIE
Last Name:MACKEY
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 1:1520 AVENUE PL STE B-100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4015
Mailing Address - Country:US
Mailing Address - Phone:404-639-5575
Mailing Address - Fax:404-639-5574
Practice Address - Street 1:1520 AVENUE PL STE B-100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4015
Practice Address - Country:US
Practice Address - Phone:404-639-5575
Practice Address - Fax:404-639-5574
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist