MEDICARE: MAKENZIE ELISABETH GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP0010216	WV

General Provider Information

NPI Number	:	1174047153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENZIE ELISABETH GREEN

Provider Business Mailing Address
First Line	:	565 E CENTENNIAL PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5633
Country	:	US
Telephone Number	:	702-399-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 E CENTENNIAL PKWY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-5633
Country	:	US
Telephone Number	:	702-399-3405
Fax Number	:	702-399-9602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	12/22/2022

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Directions to “ MAKENZIE ELISABETH GREEN ” Practice Location

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