Active NPI
McKenzie Ann Graham, PHARMD, RPH
- Pharmacist
- Riverton, WY
National Provider Identifier
1164902995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4056
- Practice address
- 845 N Federal Blvd
Riverton, WY 82501 - Phone
- (307) 857-6023
- NPI assigned
- Aug 21, 2018
- Last updated
- Jul 13, 2020
- 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 | 4056 | WY | Primary |
Addresses
Primary practice location
845 N Federal Blvd
Riverton, WY 82501
Mailing address
418 W Pershing Ave Apt 4
Riverton, WY 82501-2428
Phone (307) 331-8892
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4056 | Other | WY | WYOMING BOARD OF PHARMACY |
| 4056 | Other | WY | WYOMING BOARD OF PHARMACY IMMUNIZER LICENSE |
Other names 1
- McKenzie Ann Hellbaum
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
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4056 | WY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Community/Retail Pharmacy | Past | Accepting new patients |
| Walgreen Co | Community/Retail Pharmacy | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1164902995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 W PERSHING AVE APT 4",
"city": "RIVERTON",
"state": "WY",
"postal_code": "825012428",
"telephone_number": "307-331-8892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 N FEDERAL BLVD",
"city": "RIVERTON",
"state": "WY",
"postal_code": "82501",
"telephone_number": "307-857-6023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "MCKENZIE",
"middle_name": "ANN",
"credential": "PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-21",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WY",
"license": "4056",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WYOMING BOARD OF PHARMACY",
"identifier": "4056",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WYOMING BOARD OF PHARMACY IMMUNIZER LICENSE",
"identifier": "4056",
"state": "WY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MCKENZIE",
"last_name": "HELLBAUM",
"middle_name": "ANN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Riverton, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.