Provider Demographics
NPI:1770184228
Name:MCDONALD, ELEANOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 MADISON 3640
Mailing Address - Street 2:
Mailing Address - City:WITTER
Mailing Address - State:AR
Mailing Address - Zip Code:72776-8920
Mailing Address - Country:US
Mailing Address - Phone:479-236-8286
Mailing Address - Fax:
Practice Address - Street 1:4253 N CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4593
Practice Address - Country:US
Practice Address - Phone:479-684-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD10286OtherPHARMACY LICENSE NUMBER