Provider Demographics
NPI:1689946709
Name:MCDONALD, ROBERT W (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 ALFONSO DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2030
Mailing Address - Country:US
Mailing Address - Phone:585-227-5677
Mailing Address - Fax:
Practice Address - Street 1:2050 LATTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3746
Practice Address - Country:US
Practice Address - Phone:585-663-6950
Practice Address - Fax:585-663-5248
Is Sole Proprietor?:No
Enumeration Date:2012-02-05
Last Update Date:2012-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist