Healthcare Provider Details

I. General information

NPI: 1073682852
Provider Name (Legal Business Name): MCDONALD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 JAMES E HANNAH DR
SOUTH SHORE KY
41175-9600
US

IV. Provider business mailing address

PO BOX 774
SOUTH SHORE KY
41175-0774
US

V. Phone/Fax

Practice location:
  • Phone: 606-932-3614
  • Fax: 606-932-3614
Mailing address:
  • Phone: 606-932-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01070
License Number StateKY

VIII. Authorized Official

Name: DAVID BRADLEY STULTZ
Title or Position: PIC
Credential: RPH
Phone: 606-922-5512