Provider Demographics
NPI:1831495464
Name:MACKENZIE, MICHELINE (RPH)
Entity type:Individual
Prefix:MS
First Name:MICHELINE
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 MORRIS AVE
Mailing Address - Street 2:#2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6625
Mailing Address - Country:US
Mailing Address - Phone:718-367-6126
Mailing Address - Fax:
Practice Address - Street 1:2420 MORRIS AVE
Practice Address - Street 2:#2D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6625
Practice Address - Country:US
Practice Address - Phone:718-367-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-29
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055073-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist