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General NPI Number Information
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NPI Number | 1780931402
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Entity Type | Individual
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Provider Name | MACKENZIE LAUREN MULLENIX PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 9 PIEDMONT CTR NE BLDG 10, SUITE 412
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City | ATLANTA
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State | GA
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Zip | 30305-1733
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Country | US
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Telephone | 770-514-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 207 TREYBURN CIR
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City | IRMO
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State | SC
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Zip | 29063-8001
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Country | US
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Telephone | 803-749-0003
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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 | 13803
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 027400
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License Number State | GA
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