Provider Demographics
NPI:1174684047
Name:DELASHMUTT, DONN PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:DONN
Middle Name:PAUL
Last Name:DELASHMUTT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1219
Mailing Address - Country:US
Mailing Address - Phone:402-492-8143
Mailing Address - Fax:
Practice Address - Street 1:10004 S 152ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3930
Practice Address - Country:US
Practice Address - Phone:402-896-5000
Practice Address - Fax:402-896-3774
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist