Provider Demographics
NPI:1447575899
Name:MCDONALD, KEVIN P
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4425
Mailing Address - Country:US
Mailing Address - Phone:586-739-4200
Mailing Address - Fax:586-739-6412
Practice Address - Street 1:7601 23 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4425
Practice Address - Country:US
Practice Address - Phone:586-739-4200
Practice Address - Fax:586-739-6412
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist