Provider Demographics
NPI:1134794241
Name:MCDONALD, KEVIN WAYNE II
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WAYNE
Last Name:MCDONALD
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ENCLAVE DR APT 4115
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5035
Mailing Address - Country:US
Mailing Address - Phone:281-569-9488
Mailing Address - Fax:
Practice Address - Street 1:112 HIGHWAY 146 S. STE B
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:281-842-8500
Practice Address - Fax:281-842-8505
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist