Provider Demographics
NPI:1295450385
Name:BAIN, MACKENZIE RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:BAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 EMERALD WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2858
Mailing Address - Country:US
Mailing Address - Phone:401-793-1646
Mailing Address - Fax:
Practice Address - Street 1:189 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2571
Practice Address - Country:US
Practice Address - Phone:617-332-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000Other000