Provider Demographics
NPI:1265641179
Name:DEWBERRY, DONNA MOSELEY (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MOSELEY
Last Name:DEWBERRY
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 1:5403 NC 96 HWY N
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576
Mailing Address - Country:US
Mailing Address - Phone:919-965-4659
Mailing Address - Fax:
Practice Address - Street 1:JOHNSTON MEMORIAL HOSPITAL
Practice Address - Street 2:509 N BRIGHTLEAF BLVD.
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-934-8171
Practice Address - Fax:919-934-2274
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist