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General NPI Number Information
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NPI Number | 1578553723
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Entity Type | Organization
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Legal Business Name | MCKENZIE DRUGS & COMPOUNDING CENTER INC
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 4814 HWY 78 STE 10
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City | LILBURN
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State | GA
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Zip | 30047-4649
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Country | US
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Telephone | 770-972-6050
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Fax | 770-972-6051
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Provider Business Mailing Address
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Address Line | 4814 HWY 78 STE 10
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City | LILBURN
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State | GA
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Zip | 30047-4649
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Country | US
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Telephone | 770-972-6050
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Fax | 770-972-6051
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | WILL SMITH
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Credential | PHARM.D.
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Telephone | 770-972-6050
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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 | 5212
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License Number State | GA
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