Provider Demographics
NPI:1386637197
Name:MCDONOUGH, DAVID J (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1507
Mailing Address - Country:US
Mailing Address - Phone:419-678-3435
Mailing Address - Fax:419-678-8511
Practice Address - Street 1:120 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1507
Practice Address - Country:US
Practice Address - Phone:419-678-3435
Practice Address - Fax:419-678-8511
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist