Provider Demographics
NPI:1245397793
Name:FOX, DONALD BLAIR SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:BLAIR
Last Name:FOX
Suffix:SR
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 1:2100 MONUMENT BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3489
Mailing Address - Country:US
Mailing Address - Phone:925-685-0147
Mailing Address - Fax:925-685-0308
Practice Address - Street 1:2100 MONUMENT BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3489
Practice Address - Country:US
Practice Address - Phone:925-685-0147
Practice Address - Fax:925-685-0308
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0540939OtherNCPDP
CAPHY19491OtherCALIFORNIA LICENSE
CAPHA194910Medicaid
CAPHY19491OtherCALIFORNIA LICENSE