Provider Demographics
NPI:1215542097
Name:ARDOIN, DONNA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 DISHMAN RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-3831
Mailing Address - Country:US
Mailing Address - Phone:409-658-0100
Mailing Address - Fax:
Practice Address - Street 1:295 HIGHWAY 105 E
Practice Address - Street 2:
Practice Address - City:SOUR LAKE
Practice Address - State:TX
Practice Address - Zip Code:77659-7783
Practice Address - Country:US
Practice Address - Phone:409-287-3525
Practice Address - Fax:409-287-2295
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist