Individual
JEROLD A MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4860 HONONEGAH RD, ROSCOE, IL 61073-7777
(815) 623-7798
(815) 623-9479
Mailing address
4860 HONONEGAH RD, ROSCOE, IL 61073-7777
(815) 623-7798
(815) 623-9479
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.039948
IL
333600000X
Pharmacy
051.039948
IL
Other
Enumeration date
07/13/2018
Last updated
07/13/2018
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