Provider Demographics
NPI:1013290527
Name:MACDONALD, JOHN A (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MACDONALD
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 1:4700 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-4416
Mailing Address - Country:US
Mailing Address - Phone:773-927-8777
Mailing Address - Fax:773-927-4399
Practice Address - Street 1:4700 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4416
Practice Address - Country:US
Practice Address - Phone:773-927-8777
Practice Address - Fax:773-927-4399
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-033915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist