Provider Demographics
NPI:1043303266
Name:WILLETT, DONALD CHARLES (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CHARLES
Last Name:WILLETT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:DONALD
Other - Middle Name:CHARLES
Other - Last Name:WILLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:975 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2755
Mailing Address - Country:US
Mailing Address - Phone:330-722-3676
Mailing Address - Fax:
Practice Address - Street 1:10000 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3204
Practice Address - Country:US
Practice Address - Phone:440-526-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist