MEDICARE: KATHRYN MCDONNELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP438451	PA

General Provider Information

NPI Number	:	1194197988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MCDONNELL

Provider Business Mailing Address
First Line	:	1400 E PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-5611
Country	:	US
Telephone Number	:	215-551-3321
Fax Number	:	215-551-3449

Provider Business Practice Location Address
First Line	:	1400 E PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-5611
Country	:	US
Telephone Number	:	215-551-3321
Fax Number	:	215-551-3449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/20/2015

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Directions to “ KATHRYN MCDONNELL ” Practice Location

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