Healthcare Provider Details

I. General information

NPI: 1558084624
Provider Name (Legal Business Name): MCKENZIE LLAPUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 HIGHLAND AVE NE
ATLANTA GA
30312-1321
US

IV. Provider business mailing address

439 HIGHLAND AVE NE
ATLANTA GA
30312-1321
US

V. Phone/Fax

Practice location:
  • Phone: 404-230-9385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH032200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: