Active NPI
Makenzie Elisabeth Green
- Pharmacist
- North Las Vegas, NV
National Provider Identifier
1174047153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP0010216
- Practice address
- 565 E Centennial Pkwy
North Las Vegas, NV 89081-5633 - Phone
- (702) 399-3405
- Fax
- (702) 399-9602
- NPI assigned
- Aug 1, 2017
- Last updated
- Dec 22, 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 | RP0010216 | WV | Primary |
Addresses
Primary practice location
565 E Centennial Pkwy
North Las Vegas, NV 89081-5633
Mailing address
565 E Centennial Pkwy
North Las Vegas, NV 89081-5633
Phone (702) 399-3405
Other practice location 1
111 4th Ave
Huntington, WV 25701-1219
Phone (304) 523-3502
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 |
|---|---|---|---|
| RP0010216 | WV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
565 E Centennial Pkwy
North Las Vegas, NV 89081
Phone (702) 399-3405
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": "1501545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1174047153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 E CENTENNIAL PKWY",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890815633",
"telephone_number": "702-399-3405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "565 E CENTENNIAL PKWY",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890815633",
"telephone_number": "702-399-3405",
"fax_number": "702-399-9602"
}
],
"practiceLocations": [
{
"address_1": "111 4th Ave",
"address_purpose": "LOCATION",
"city": "Huntington",
"state": "WV",
"postal_code": "257011219",
"country_code": "US",
"telephone_number": "304-523-3502",
"fax_number": "304-522-0891",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREEN",
"first_name": "MAKENZIE",
"middle_name": "ELISABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-01",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0010216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.