Provider Demographics
NPI:1518267517
Name:CONSTANCE, DONNA N (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:N
Last Name:CONSTANCE
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 1:232 G ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2019
Mailing Address - Country:US
Mailing Address - Phone:719-539-6933
Mailing Address - Fax:
Practice Address - Street 1:232 G ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2019
Practice Address - Country:US
Practice Address - Phone:719-539-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17267183500000X
MI5302021146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist