Healthcare Provider Details

I. General information

NPI: 1720521297
Provider Name (Legal Business Name): MACKENZIE STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 MAIN ST
POUGHKEEPSIE NY
12601-3700
US

IV. Provider business mailing address

126 CATHERINE ST FLOOR 1
BEACON NY
12508-3027
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number062580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: