Healthcare Provider Details

I. General information

NPI: 1760392609
Provider Name (Legal Business Name): MACEY BIBBY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MACEY GRAHAM

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 N 60TH ST
MILWAUKEE WI
53208-1045
US

IV. Provider business mailing address

2205 N 60TH ST
MILWAUKEE WI
53208-1045
US

V. Phone/Fax

Practice location:
  • Phone: 414-218-4681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2200740
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: