Provider Demographics
NPI:1174957336
Name:MACDONALD, DANIEL J (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FURLONG DR
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4006
Mailing Address - Country:US
Mailing Address - Phone:781-922-6031
Mailing Address - Fax:
Practice Address - Street 1:36 FURLONG DR
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4006
Practice Address - Country:US
Practice Address - Phone:781-922-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist