Healthcare Provider Details

I. General information

NPI: 1396346003
Provider Name (Legal Business Name): MACKENZIE LEE ELISZEWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
CAMBRIDGE WI
53523-9141
US

IV. Provider business mailing address

PO BOX 69
CAMBRIDGE WI
53523-0069
US

V. Phone/Fax

Practice location:
  • Phone: 608-423-3231
  • Fax: 608-423-7128
Mailing address:
  • Phone: 608-423-3231
  • Fax: 608-423-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19968-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: