Provider Demographics
NPI:1407076813
Name:HARGROVE, DEONNA EMERSON (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEONNA
Middle Name:EMERSON
Last Name:HARGROVE
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 1:12808 CREEKBEND COURT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8171
Mailing Address - Country:US
Mailing Address - Phone:502-645-6991
Mailing Address - Fax:
Practice Address - Street 1:12808 CREEKBEND CT
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8171
Practice Address - Country:US
Practice Address - Phone:502-645-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13120OtherPHARMACIST LICENSE
KY011965OtherPHARMACIST LICENSE