Provider Demographics
NPI:1275670663
Name:FELLOWS, DONALD KERMIT JR (PD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:KERMIT
Last Name:FELLOWS
Suffix:JR
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3313
Mailing Address - Country:US
Mailing Address - Phone:985-345-5120
Mailing Address - Fax:985-345-5178
Practice Address - Street 1:125 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3313
Practice Address - Country:US
Practice Address - Phone:985-345-5120
Practice Address - Fax:985-345-5178
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist