Healthcare Provider Details

I. General information

NPI: 1023955895
Provider Name (Legal Business Name): MACKENZIE LESEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 UNIVERSITY EXEC PARK DR STE 127
CHARLOTTE NC
28262-1358
US

IV. Provider business mailing address

8401 UNIVERSITY EXEC PARK DR STE 127
CHARLOTTE NC
28262-1358
US

V. Phone/Fax

Practice location:
  • Phone: 855-307-6868
  • Fax:
Mailing address:
  • Phone: 855-307-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30118
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: