Healthcare Provider Details

I. General information

NPI: 1407454028
Provider Name (Legal Business Name): MCKENZIE MARIE KILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N HOUK RD
DELAWARE OH
43015-4418
US

IV. Provider business mailing address

122 HAWTHORNE RD
SUNBURY OH
43074-9231
US

V. Phone/Fax

Practice location:
  • Phone: 740-362-8426
  • Fax:
Mailing address:
  • Phone: 740-362-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03440098
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302412868
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: