Healthcare Provider Details

I. General information

NPI: 1467041012
Provider Name (Legal Business Name): MAKENZIE PSARAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 WESTBRANCH HWY
LEWISBURG PA
17837-6353
US

IV. Provider business mailing address

90 HIGH POINT DR
MILTON PA
17847-8158
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-5757
  • Fax:
Mailing address:
  • Phone: 570-505-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: