Provider Demographics
NPI:1912208224
Name:MACKIE, ABBY MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:MICHELLE
Last Name:MACKIE
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 1:19845 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4837
Mailing Address - Country:US
Mailing Address - Phone:661-250-8547
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5764
Practice Address - Country:US
Practice Address - Phone:661-255-7910
Practice Address - Fax:661-255-7987
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59880183500000X
KS1-13716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist