Provider Demographics
NPI:1902129299
Name:MAY, DONALD D (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:D
Last Name:MAY
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:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0024
Mailing Address - Country:US
Mailing Address - Phone:618-244-5400
Mailing Address - Fax:618-244-5988
Practice Address - Street 1:3401 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2201
Practice Address - Country:US
Practice Address - Phone:618-244-5400
Practice Address - Fax:618-244-5988
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051029500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist