Active NPI
Marilyn Mary Mackinnon
- Pharmacist
- Stoughton, WI
National Provider Identifier
1114203296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14888-040
- Practice address
- 1705 Highway Fifty One
Stoughton, WI 53589 - Phone
- (608) 873-7612
- Fax
- (608) 873-7894
- NPI assigned
- Nov 2, 2011
- 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 | 14888-040 | WI | Primary |
Addresses
Primary practice location
1705 Highway Fifty One
Stoughton, WI 53589
Mailing address
1705 Highway 51
Stoughton, WI 53589
Phone (608) 873-7612
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 |
|---|---|---|---|
| 14888-040 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1114203296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 HIGHWAY 51",
"city": "STOUGHTON",
"state": "WI",
"postal_code": "53589",
"telephone_number": "608-873-7612",
"fax_number": "608-873-7894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1705 HIGHWAY FIFTY ONE",
"city": "STOUGHTON",
"state": "WI",
"postal_code": "53589",
"telephone_number": "608-873-7612",
"fax_number": "608-873-7894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKINNON",
"first_name": "MARILYN",
"middle_name": "MARY",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-02",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "14888-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stoughton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.