Healthcare Provider Details

I. General information

NPI: 1306459342
Provider Name (Legal Business Name): JOHANA LIZETH MCDONALD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N WOODLAND DR
FOREST MS
39074-3307
US

IV. Provider business mailing address

219 N WOODLAND DR
FOREST MS
39074-3307
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-3393
  • Fax: 601-469-5965
Mailing address:
  • Phone: 601-469-3393
  • Fax: 601-469-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-15792
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: