Provider Demographics
NPI:1548693369
Name:MCDONALD, CHAD W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:W
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PARK PL
Mailing Address - Street 2:APT 118B
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1429
Mailing Address - Country:US
Mailing Address - Phone:601-434-2290
Mailing Address - Fax:
Practice Address - Street 1:6130 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7300
Practice Address - Country:US
Practice Address - Phone:601-545-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP12974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist