Provider Demographics
NPI:1902635907
Name:CARLE, MCKENZIE (RPH)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:CARLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 WALKERTON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-1843
Mailing Address - Country:US
Mailing Address - Phone:513-446-8188
Mailing Address - Fax:
Practice Address - Street 1:1220 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3118
Practice Address - Country:US
Practice Address - Phone:859-491-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY024481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist