Provider Demographics
NPI:1851848378
Name:MACDONALD, JAMES GRAE (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GRAE
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 ELDRON BLVD SE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6870
Mailing Address - Country:US
Mailing Address - Phone:321-308-0303
Mailing Address - Fax:321-308-0310
Practice Address - Street 1:1850 ELDRON BLVD SE
Practice Address - Street 2:SUITE 7
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6870
Practice Address - Country:US
Practice Address - Phone:321-308-0303
Practice Address - Fax:321-308-0310
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37463183500000X
KY015806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist