Provider Demographics
NPI:1689978827
Name:MCDUNNAH, MARY GRAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GRAY
Last Name:MCDUNNAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5496 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-9215
Mailing Address - Country:US
Mailing Address - Phone:228-467-6652
Mailing Address - Fax:
Practice Address - Street 1:5496 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-9215
Practice Address - Country:US
Practice Address - Phone:228-467-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist