Active NPI
Mackenzie Carlbom
- Pharmacist
- Rapid City, SD
National Provider Identifier
1124742994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 7004
- Practice address
- 1200 N Lacrosse St
Rapid City, SD 57701-6965 - Phone
- (605) 342-0881
- NPI assigned
- Sep 26, 2022
- Last updated
- Sep 26, 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 | 7004 | SD | Primary |
Addresses
Primary practice location
1200 N Lacrosse St
Rapid City, SD 57701-6965
Mailing address
820 Pro Rodeo Dr
Spearfish, SD 57783-9599
Phone (605) 641-4252
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 |
|---|---|---|---|
| 7004 | SD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1124742994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 PRO RODEO DR",
"city": "SPEARFISH",
"state": "SD",
"postal_code": "577839599",
"telephone_number": "605-641-4252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N LACROSSE ST",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577016965",
"telephone_number": "605-342-0881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLBOM",
"first_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SD",
"license": "7004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.