Provider Demographics
NPI:1982913638
Name:MACDONELL, JUDITH THOMPSON (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:THOMPSON
Last Name:MACDONELL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TALL PINE CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4539
Mailing Address - Country:US
Mailing Address - Phone:706-729-9494
Mailing Address - Fax:
Practice Address - Street 1:4 TALL PINE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4539
Practice Address - Country:US
Practice Address - Phone:706-729-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist