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1073660478 NPI number — MCKENZIE MANSFIELD PHARMACY SERVICES, LLC

NPI Number: 1073660478
Health Care Provider/Practitioner: MCKENZIE MANSFIELD PHARMACY SERVICES, LLC

Information about “1073660478” NPI (MCKENZIE MANSFIELD PHARMACY SERVICES, LLC) exists in 1073660478 in HTML format HTML  |  1073660478 in plain Text format TXT  |  1073660478 in PDF (Portable Document Format) PDF  |  1073660478 in an XML format XML  formats.

NPI Number : 1073660478 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073660478",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MCKENZIE MANSFIELD PHARMACY SERVICES, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4825 ROCKBRIDGE RD",
    "SecondLineMailingAddress": "SUITES 5 & 6",
    "MailingAddressCityName": "STONE MOUNTAIN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30083-4297",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4825 ROCKBRIDGE RD",
    "SecondLinePracticeLocationAddress": "SUITES 5 & 6",
    "PracticeLocationAddressCityName": "STONE MOUNTAIN",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30083-4297",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-297-3456",
    "PracticeLocationAddressFaxNumber": "404-297-4790",
    "EnumerationDate": "01/05/2007",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HARRIS",
    "AuthorizedOfficialFirstName": "LUIS",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHARMACIST",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "404-297-3456",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": "PHRE008733",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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