Provider Demographics
NPI:1982977609
Name:GREENLEE, MACKIE P (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:MACKIE
Middle Name:P
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 HIGHWAY 407
Mailing Address - Street 2:
Mailing Address - City:KILMICHAEL
Mailing Address - State:MS
Mailing Address - Zip Code:39747-9609
Mailing Address - Country:US
Mailing Address - Phone:662-262-7949
Mailing Address - Fax:
Practice Address - Street 1:2266 HIGHWAY 407
Practice Address - Street 2:
Practice Address - City:KILMICHAEL
Practice Address - State:MS
Practice Address - Zip Code:39747-9609
Practice Address - Country:US
Practice Address - Phone:662-262-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist