Provider Demographics
NPI:1215082474
Name:PAUL B MACDONALD'S PHARMACY INC
Entity type:Organization
Organization Name:PAUL B MACDONALD'S PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COOWNER AND PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOSCH
Authorized Official - Last Name:SHETTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-485-3622
Mailing Address - Street 1:214 PEACH ORCHARD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-8559
Mailing Address - Country:US
Mailing Address - Phone:717-485-3622
Mailing Address - Fax:717-485-5176
Practice Address - Street 1:214 PEACH ORCHARD RD STE 100
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8559
Practice Address - Country:US
Practice Address - Phone:717-485-3622
Practice Address - Fax:717-485-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411441L183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011371360003Medicaid
PA0011371360002Medicaid
PA0011371360003Medicaid