Provider Demographics
NPI:1790357523
Name:MCDONALD, WILLARD EVAN (RPH)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:EVAN
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 1:313 E PUSHMATAHA ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2533
Mailing Address - Country:US
Mailing Address - Phone:205-459-3710
Mailing Address - Fax:
Practice Address - Street 1:313 E PUSHMATAHA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2533
Practice Address - Country:US
Practice Address - Phone:205-459-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist