Healthcare Provider Details

I. General information

NPI: 1831011253
Provider Name (Legal Business Name): MACKENZIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 COURT ST
FULTON MO
65251-1901
US

IV. Provider business mailing address

703 STANFORD ST
JEFFERSON CITY MO
65109-0668
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-4186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026035313
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: