Provider Demographics
NPI:1811515927
Name:MCDONALD, KRISTIN LYNNE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MS
Mailing Address - Zip Code:39327-8977
Mailing Address - Country:US
Mailing Address - Phone:601-701-4975
Mailing Address - Fax:
Practice Address - Street 1:82 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327-8977
Practice Address - Country:US
Practice Address - Phone:601-701-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16094183500000X
MSE-010395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist