Provider Demographics
NPI:1396065918
Name:MCGUIRE, DONALD MIXER
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:MIXER
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90038-1022
Mailing Address - Country:US
Mailing Address - Phone:323-463-8539
Mailing Address - Fax:323-463-0311
Practice Address - Street 1:1132 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038-1022
Practice Address - Country:US
Practice Address - Phone:323-463-8539
Practice Address - Fax:323-463-0311
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist