Provider Demographics
NPI:1063192086
Name:MACKIE, SAVANNAH BROOKE (PHARMD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:BROOKE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 GREENDALE RD UNIT 11105
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8343
Mailing Address - Country:US
Mailing Address - Phone:606-831-2217
Mailing Address - Fax:
Practice Address - Street 1:2209 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1306
Practice Address - Country:US
Practice Address - Phone:859-269-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist