Individual
DEBRA MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5026
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5026
Taxonomy
Speciality
Code
Description
License number
State
1835P0200X
Pediatric Pharmacist
Primary
P5366
ID
Other
Enumeration date
12/24/2019
Last updated
12/24/2019
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