Provider Demographics
NPI:1295826063
Name:MCDONALD, KEITH JEFFREY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:JEFFREY
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:BRENDAN
Other - Middle Name:JEFFREY
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:29903 9TH PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3748
Mailing Address - Country:US
Mailing Address - Phone:253-946-6817
Mailing Address - Fax:
Practice Address - Street 1:PUGET SOUND HEALTH CARE SYSTEM AMERICAN LAKE DIVISION
Practice Address - Street 2:A-111-PC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-5000
Practice Address - Country:US
Practice Address - Phone:253-583-2312
Practice Address - Fax:253-589-4150
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist