Provider Demographics
NPI:1821382847
Name:MCDONALD, AMANDA MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MICHELLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E EDGEWOOD BLVD
Mailing Address - Street 2:T-0361
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-5901
Mailing Address - Country:US
Mailing Address - Phone:517-882-4845
Mailing Address - Fax:517-882-4845
Practice Address - Street 1:500 E EDGEWOOD BLVD
Practice Address - Street 2:T-0361
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5901
Practice Address - Country:US
Practice Address - Phone:517-882-4845
Practice Address - Fax:517-882-4845
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist