Provider Demographics
NPI:1134466196
Name:PEARSON, DONALD RAY
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13609 ADMIRAL CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5628
Mailing Address - Country:US
Mailing Address - Phone:239-561-5730
Mailing Address - Fax:
Practice Address - Street 1:6900 DANIELS PKWY STE 19
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1586
Practice Address - Country:US
Practice Address - Phone:239-768-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist