Provider Demographics
NPI:1740275510
Name:MACDONALD PHARMACY ASSOCIATES, INC.
Entity type:Organization
Organization Name:MACDONALD PHARMACY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-867-3701
Mailing Address - Street 1:115 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1605
Mailing Address - Country:US
Mailing Address - Phone:610-867-3701
Mailing Address - Fax:610-866-1499
Practice Address - Street 1:115 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1605
Practice Address - Country:US
Practice Address - Phone:610-867-3701
Practice Address - Fax:610-866-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411216L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0577120Medicaid