Provider Demographics
NPI:1033927728
Name:VALENTIN, MCKENZIE TAYLOR (PHARMD)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:TAYLOR
Last Name:VALENTIN
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 1:179 BEACH 73RD ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1267
Mailing Address - Country:US
Mailing Address - Phone:347-494-8164
Mailing Address - Fax:
Practice Address - Street 1:8807 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1600
Practice Address - Country:US
Practice Address - Phone:718-310-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist