Individual
DEZARAY LAZAIR MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
3606 N NEWTON ST, JASPER, IN 47546-9601
(812) 481-1513
(812) 481-1593
Mailing address
3606 N NEWTON ST, JASPER, IN 47546-9601
(812) 481-1513
(812) 481-1513
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26028446A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7120015026
DRIVER'S LICENSE
IN
Enumeration date
08/25/2020
Last updated
08/25/2020
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