Provider Demographics
NPI:1437158250
Name:DEHART, DONALD WILLIAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WILLIAM
Last Name:DEHART
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6426
Mailing Address - Country:US
Mailing Address - Phone:931-278-6171
Mailing Address - Fax:931-278-6172
Practice Address - Street 1:1157 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-6426
Practice Address - Country:US
Practice Address - Phone:931-278-6171
Practice Address - Fax:931-278-6172
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13919OtherSTATE PHARMACY LICENSE #
TN41623OtherSTATE PHARMACY LICENSE #