MEDICARE: JESSICA MCDONALD

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	E-09455	MS

General Provider Information

NPI Number	:	1104281781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MCDONALD

Provider Business Mailing Address
First Line	:	7100 HIGHWAY 614
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-7395
Country	:	US
Telephone Number	:	228-588-2888
Fax Number	:	228-588-2890

Provider Business Practice Location Address
First Line	:	7100 HIGHWAY 614
Second Line	:
City	:	MOSS POINT
State	:	MS
Zip	:	39562-7395
Country	:	US
Telephone Number	:	228-588-2888
Fax Number	:	228-588-2890

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

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/23/2015

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