MEDICARE: JAMES KEVIN MC DONALD RPH

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	4707	TN

General Provider Information

NPI Number	:	1942296827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES KEVIN MC DONALD RPH

Provider Business Mailing Address
First Line	:	3423 SUMMER AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3609
Country	:	US
Telephone Number	:	901-452-2189
Fax Number	:	901-452-2167

Provider Business Practice Location Address
First Line	:	3423 SUMMER AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3609
Country	:	US
Telephone Number	:	901-452-2189
Fax Number	:	901-452-2167

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/08/2007

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