Active NPI
Stacey McKenzie
- Pharmacist
- Saint Croix Falls, WI
National Provider Identifier
1063163533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21217
- Practice address
- 2212 Glacier Dr
Saint Croix Falls, WI 54024-8347 - Phone
- (715) 483-1499
- NPI assigned
- Jan 15, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 21217 | WI | Primary |
Addresses
Primary practice location
2212 Glacier Dr
Saint Croix Falls, WI 54024-8347
Mailing address
2212 Glacier Dr
Saint Croix Falls, WI 54024-8347
Phone (715) 483-1499
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Phone |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21217 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642204800000",
"number": "1063163533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2212 GLACIER DR",
"city": "SAINT CROIX FALLS",
"state": "WI",
"postal_code": "540248347",
"telephone_number": "715-483-1499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2212 GLACIER DR",
"city": "SAINT CROIX FALLS",
"state": "WI",
"postal_code": "540248347",
"telephone_number": "715-483-1499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENZIE",
"first_name": "STACEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-15",
"last_updated": "2022-01-15",
"certification_date": "2022-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "21217",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Phone",
"affiliation": "N",
"address_1": "2212 Glacier Dr",
"city": "Saint Croix Falls",
"state": "WI",
"country_code": "US",
"postal_code": "540248347",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Croix Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.