Provider Demographics
NPI:1699151837
Name:MCKENZIE, CHARLES PHILLIP (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILLIP
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 DOROTHYS DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541-7653
Mailing Address - Country:US
Mailing Address - Phone:843-319-6827
Mailing Address - Fax:
Practice Address - Street 1:2015 S IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3419
Practice Address - Country:US
Practice Address - Phone:843-292-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist