Provider Demographics
NPI:1437212602
Name:DEBOER, DONALD WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WAYNE
Last Name:DEBOER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WEST 3RD STREET
Mailing Address - Street 2:BOX 552
Mailing Address - City:SANBORN
Mailing Address - State:IA
Mailing Address - Zip Code:51248-0552
Mailing Address - Country:US
Mailing Address - Phone:712-930-3575
Mailing Address - Fax:
Practice Address - Street 1:1501 PARK ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1304
Practice Address - Country:US
Practice Address - Phone:712-324-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist