Provider Demographics
NPI:1518908284
Name:ANDERSON, DONNA (RPH)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:ANDERSON
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 1:3005 BROOKHOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7525
Mailing Address - Country:US
Mailing Address - Phone:972-355-4614
Mailing Address - Fax:972-355-5502
Practice Address - Street 1:1001 CROSS TIMBERS RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-8812
Practice Address - Country:US
Practice Address - Phone:972-355-4614
Practice Address - Fax:972-355-4614
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist