Provider Demographics
NPI:1003184029
Name:DONNELLY, STEVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DONNELLY
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 1:1704 INGERSOLL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3332
Mailing Address - Country:US
Mailing Address - Phone:515-657-8896
Mailing Address - Fax:515-657-8897
Practice Address - Street 1:1704 INGERSOLL AVE STE 102
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3332
Practice Address - Country:US
Practice Address - Phone:515-657-8896
Practice Address - Fax:515-657-8897
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48953183500000X
IA21614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist