Provider Demographics
NPI:1275850596
Name:MCDONALD, LAURA DENISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DENISE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:DENISE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:603 LOUIS HENNA BLVD # A
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7186
Mailing Address - Country:US
Mailing Address - Phone:512-828-0814
Mailing Address - Fax:512-828-0854
Practice Address - Street 1:603 LOUIS HENNA BLVD # A
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7186
Practice Address - Country:US
Practice Address - Phone:512-828-0814
Practice Address - Fax:512-828-0854
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist