Provider Demographics
NPI:1447856141
Name:MCDONALD, ROBERT JESSIE (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JESSIE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20813 NE MCDONALD LN
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-8115
Mailing Address - Country:US
Mailing Address - Phone:850-674-5285
Mailing Address - Fax:
Practice Address - Street 1:CVS 04480
Practice Address - Street 2:1037 MAIN ST.
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-0017
Practice Address - Country:US
Practice Address - Phone:850-638-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist