Healthcare Provider Details

I. General information

NPI: 1538253224
Provider Name (Legal Business Name): MCKENZIE PRESCRIPTION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 N MORLEY ST SUITE A
MOBERLY MO
65270-2500
US

IV. Provider business mailing address

643 N MORLEY ST STE A
MOBERLY MO
65270-2500
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-6710
  • Fax: 660-263-2269
Mailing address:
  • Phone: 660-263-6710
  • Fax: 660-263-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPS003394
License Number StateMO

VIII. Authorized Official

Name: MR. DENNIS BERDING
Title or Position: OWNER
Credential: RPH
Phone: 660-263-6710