Provider Demographics
NPI:1124807888
Name:METCALF, MCKENZIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:METCALF
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 1:2055 NW 29TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5306
Mailing Address - Country:US
Mailing Address - Phone:503-928-9849
Mailing Address - Fax:
Practice Address - Street 1:7411 NE 117TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-4706
Practice Address - Country:US
Practice Address - Phone:360-896-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61465293183500000X
ORRPH-0019714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist