Provider Demographics
NPI:1275804817
Name:O'NEAL, DONNA SMOLKO
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:SMOLKO
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 176TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1225
Mailing Address - Country:US
Mailing Address - Phone:727-947-2647
Mailing Address - Fax:727-391-0722
Practice Address - Street 1:13705 78TH AVE N
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-1702
Practice Address - Country:US
Practice Address - Phone:727-319-2757
Practice Address - Fax:727-391-0722
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23319183500000X
IDP6243183500000X
GA015630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026920400Medicaid