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General NPI Number Information
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NPI Number | 1508249970
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Entity Type | Individual
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Provider Name | MACKENZIE LEE DACRE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2015
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 132 GRANITE ST
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City | QUINCY
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State | MA
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Zip | 02169-5060
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Country | US
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Telephone | 617-479-2330
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Fax | 617-479-2601
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Provider Business Mailing Address
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Address Line | 132 GRANITE ST
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City | QUINCY
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State | MA
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Zip | 02169-5060
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Country | US
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Telephone | 617-479-2330
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Fax | 617-479-2601
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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 | PH235938
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License Number State | MA
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