Provider Demographics
NPI:1518290790
Name:MAUTE, DONALD J (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:MAUTE
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 1:2400 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 LEE HWY
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:540-994-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-06
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043011183500000X
VA0202212618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist