MACKENZIE PHYLLICE PURDY Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****50

License Status

ACTIVE

Business

First Name

MACKENZIE

Middle

PHYLLICE

Last Name

PURDY

Business Name

MACKENZIE PHYLLICE PURDY

Original Issue Date

08/14/2019

Effective Date

06/17/2023

Expiration Date

07/31/2026

City

SWANSEA

State

Zip

62226

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

06/17/2023