Provider Demographics
NPI:1033456926
Name:DONALDSON, SHANNON GALE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:GALE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SAND LAKE RD
Mailing Address - Street 2:BUILDING 5
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7632
Mailing Address - Country:US
Mailing Address - Phone:407-856-2301
Mailing Address - Fax:407-856-3602
Practice Address - Street 1:1950 SAND LAKE RD
Practice Address - Street 2:BUILDING 5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7632
Practice Address - Country:US
Practice Address - Phone:407-856-2301
Practice Address - Fax:407-856-3602
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist