Provider Demographics
NPI:1659663458
Name:MACDONALD, JOHN EWALD (PRH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EWALD
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:PRH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:105 CREEKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1225
Mailing Address - Country:US
Mailing Address - Phone:336-692-8289
Mailing Address - Fax:336-841-4066
Practice Address - Street 1:1589 SKEET CLUB RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8817
Practice Address - Country:US
Practice Address - Phone:336-841-0488
Practice Address - Fax:336-841-4066
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8126183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist