Healthcare Provider Details

I. General information

NPI: 1013290527
Provider Name (Legal Business Name): JOHN A MACDONALD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S HALSTED ST
CHICAGO IL
60609-4416
US

IV. Provider business mailing address

4700 S HALSTED ST
CHICAGO IL
60609-4416
US

V. Phone/Fax

Practice location:
  • Phone: 773-927-8777
  • Fax: 773-927-4399
Mailing address:
  • Phone: 773-927-8777
  • Fax: 773-927-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-033915
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: