Provider Demographics
NPI:1922382175
Name:MCDONALD, MARY JANE (DPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6697 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3867
Mailing Address - Country:US
Mailing Address - Phone:901-373-6498
Mailing Address - Fax:901-373-3660
Practice Address - Street 1:6697 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3867
Practice Address - Country:US
Practice Address - Phone:901-373-6498
Practice Address - Fax:901-373-3660
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist