Provider Demographics
NPI:1336262120
Name:MCDONOUGH, PETER JOHN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 SW 76TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3479
Mailing Address - Country:US
Mailing Address - Phone:352-333-7812
Mailing Address - Fax:
Practice Address - Street 1:8585 STATE RD 200
Practice Address - Street 2:UNIT 2
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-0000
Practice Address - Country:US
Practice Address - Phone:352-854-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist