Healthcare Provider Details

I. General information

NPI: 1669610507
Provider Name (Legal Business Name): MICHAEL ANDREW MCDONALD PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11405 DUNMAGLAS DR
BATH MI
48808-9303
US

IV. Provider business mailing address

11405 DUNMAGLAS DR
BATH MI
48808-9303
US

V. Phone/Fax

Practice location:
  • Phone: 517-410-6457
  • Fax: 800-394-4810
Mailing address:
  • Phone: 517-410-6457
  • Fax: 800-394-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302031886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: