Provider Demographics
NPI:1962139394
Name:SKURAT, MCKENZIE KAY (PHARMD)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:KAY
Last Name:SKURAT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:
Other - Last Name:SKURAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2491 153RD LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4794
Mailing Address - Country:US
Mailing Address - Phone:651-263-3942
Mailing Address - Fax:
Practice Address - Street 1:3033 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4688
Practice Address - Country:US
Practice Address - Phone:612-827-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist