Active NPI
Glen McDonald
- Pharmacist
- Fayetteville, NC
National Provider Identifier
1205545936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19109
- Practice address
- 522 Owen Dr
Fayetteville, NC 28304-3432 - Phone
- (910) 484-7183
- NPI assigned
- Nov 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19109 | NC | Primary |
Addresses
Primary practice location
522 Owen Dr
Fayetteville, NC 28304-3432
Mailing address
522 Owen Dr
Fayetteville, NC 28304-3432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19109 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668988800000",
"number": "1205545936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "522 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "522 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043432",
"telephone_number": "910-484-7183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "GLEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-21",
"last_updated": "2022-11-21",
"certification_date": "2022-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "19109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.