Provider Demographics
NPI:1528679693
Name:MCDONALD, MELISSA (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
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 1:1620 S GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3460
Mailing Address - Country:US
Mailing Address - Phone:281-585-2404
Mailing Address - Fax:281-585-0709
Practice Address - Street 1:1620 S GORDON ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-3460
Practice Address - Country:US
Practice Address - Phone:281-585-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist