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General NPI Number Information
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NPI Number | 1114238284
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Entity Type | Individual
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Provider Name | MACKENZIE DEXTER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 606 N BROADWAY ST
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City | JOHNSON CITY
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State | TN
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Zip | 37601-3535
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Country | US
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Telephone | 423-232-1524
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Fax |
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Provider Business Mailing Address
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Address Line | 389 PIPER GLN
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City | GRAY
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State | TN
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Zip | 37615-3275
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Country | US
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Telephone | 607-423-7258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 33874
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License Number State | TN
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