Active NPI
George Edward Mackinnon III, PHD, RPH
- Pharmacist
- Milwaukee, WI
National Provider Identifier
1689274771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11236
- Practice address
- 8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548 - Phone
- (414) 955-7476
- NPI assigned
- Oct 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 11236 | WI | Primary |
Addresses
Primary practice location
8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548
Mailing address
8618 222ND CT
Salem, WI 53168-9077
Phone (262) 843-4847
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 Philosophy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11236 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1689274771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8618 222ND CT",
"city": "SALEM",
"state": "WI",
"postal_code": "531689077",
"telephone_number": "262-843-4847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8701 W WATERTOWN PLANK RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263548",
"telephone_number": "414-955-7476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKINNON",
"first_name": "GEORGE",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PHD, RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-28",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "11236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.