Provider Demographics
NPI:1316311137
Name:MCDONALD, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 E EVERGREEN DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7409
Mailing Address - Country:US
Mailing Address - Phone:920-739-5900
Mailing Address - Fax:
Practice Address - Street 1:3701 E EVERGREEN DR STE 1000
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7409
Practice Address - Country:US
Practice Address - Phone:920-739-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist