Provider Demographics
NPI:1770923922
Name:NYE, MAKENZIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAKENZIE
Middle Name:
Last Name:NYE
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 1:2411 W ANTHEM WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4900
Mailing Address - Country:US
Mailing Address - Phone:623-551-2465
Mailing Address - Fax:
Practice Address - Street 1:2411 W ANTHEM WAY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4900
Practice Address - Country:US
Practice Address - Phone:623-551-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS019820OtherAZ STATE BOARD OF PHARMACY