Provider Demographics
NPI:1073535928
Name:KETTLER, DONNA LYNNE (RPH , MS)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNNE
Last Name:KETTLER
Suffix:
Gender:F
Credentials:RPH , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 CORONADO WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603
Mailing Address - Country:US
Mailing Address - Phone:541-536-4129
Mailing Address - Fax:
Practice Address - Street 1:1920 WASHBURN WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603
Practice Address - Country:US
Practice Address - Phone:541-882-7714
Practice Address - Fax:866-270-6042
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist