Provider Demographics
NPI:1912245291
Name:MCDONALD, JESSE KENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:KENT
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BRUMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1304
Mailing Address - Country:US
Mailing Address - Phone:812-386-5194
Mailing Address - Fax:812-386-6531
Practice Address - Street 1:101 W BRUMFIELD AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1304
Practice Address - Country:US
Practice Address - Phone:812-386-5194
Practice Address - Fax:812-386-6531
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024082A183500000X
IL051.295504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist