Provider Demographics
NPI:1457407611
Name:MACKENZIE, ALEXANDER (NMI) (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:(NMI)
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:RPH
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 335
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34681-0335
Mailing Address - Country:US
Mailing Address - Phone:727-773-2751
Mailing Address - Fax:
Practice Address - Street 1:2844 LANDOVER DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2821
Practice Address - Country:US
Practice Address - Phone:727-773-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist