Provider Demographics
NPI:1942296827
Name:MC DONALD, JAMES KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:MC DONALD
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 1:3423 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3609
Mailing Address - Country:US
Mailing Address - Phone:901-452-2189
Mailing Address - Fax:901-452-2167
Practice Address - Street 1:3423 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3609
Practice Address - Country:US
Practice Address - Phone:901-452-2189
Practice Address - Fax:901-452-2167
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist