Provider Demographics
NPI:1083218366
Name:DONOGHUE, DIERDRE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIERDRE
Middle Name:
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 THATCHER RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3148
Mailing Address - Country:US
Mailing Address - Phone:978-283-7480
Mailing Address - Fax:
Practice Address - Street 1:6 THATCHER RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3148
Practice Address - Country:US
Practice Address - Phone:978-283-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist