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General NPI Number Information
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NPI Number | 1073660478
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Entity Type | Organization
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Legal Business Name | MCKENZIE MANSFIELD PHARMACY SERVICES, LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4825 ROCKBRIDGE RD SUITES 5 & 6
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4297
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Country | US
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Telephone | 404-297-3456
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Fax | 404-297-4790
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Provider Business Mailing Address
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Address Line | 4825 ROCKBRIDGE RD SUITES 5 & 6
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. LUIS HARRIS
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Credential |
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Telephone | 404-297-3456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE008733
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State | GA
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