Healthcare Provider Details

I. General information

NPI: 1902475437
Provider Name (Legal Business Name): MACKENZIE HORNING TENKKU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

3741 ONEIDA ST
STOW OH
44224-4214
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-1000
  • Fax:
Mailing address:
  • Phone: 330-752-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233894
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3151327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: