Provider Demographics
NPI:1134401755
Name:MCDONALD, BETH ANNE (DPH)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
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 1:101 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4638
Mailing Address - Country:US
Mailing Address - Phone:615-221-8857
Mailing Address - Fax:615-221-8865
Practice Address - Street 1:101 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4638
Practice Address - Country:US
Practice Address - Phone:615-221-8857
Practice Address - Fax:615-221-8865
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3933OtherTENNESSEE PHARMACIST LICENSE