Healthcare Provider Details

I. General information

NPI: 1134041213
Provider Name (Legal Business Name): MACKENZIE GINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 WALKER BLDG WAR EAGLE WAY
AUBURN AL
36849-0001
US

IV. Provider business mailing address

1171 DOUGLAS STREET
OPELIKA AL
36801
US

V. Phone/Fax

Practice location:
  • Phone: 334-844-8938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: