Provider Demographics
NPI:1306893052
Name:MCDONALD, PAULA L (RPH)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7746 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-9628
Mailing Address - Country:US
Mailing Address - Phone:701-640-2745
Mailing Address - Fax:
Practice Address - Street 1:387 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4653
Practice Address - Country:US
Practice Address - Phone:701-642-2336
Practice Address - Fax:701-642-1470
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN091062700Medicaid
SD9167120Medicaid
ND21128Medicaid
ND0776850001Medicare NSC
ND0776850001Medicare ID - Type UnspecifiedND MEDICARE