Provider Demographics
NPI:1376552687
Name:NETTLETON, DONALD WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WAYNE
Last Name:NETTLETON
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Gender:M
Credentials:RPH
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Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:RAPID CITY REGIONAL HOSPITAL CANCER CARE INSTITUTE
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7375
Mailing Address - Country:US
Mailing Address - Phone:605-719-8182
Mailing Address - Fax:605-719-1003
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:RAPID CITY REGIONAL HOSPITAL PHARMACY
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-719-8182
Practice Address - Fax:605-719-1003
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-09-24
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Provider Licenses
StateLicense IDTaxonomies
SDR4323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist