Provider Demographics
NPI:1578775185
Name:DONNER, THOMAS F (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:F
Last Name:DONNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1579 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-8533
Mailing Address - Country:US
Mailing Address - Phone:515-955-1766
Mailing Address - Fax:515-576-4078
Practice Address - Street 1:115 S 29TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2951
Practice Address - Country:US
Practice Address - Phone:515-576-5320
Practice Address - Fax:515-576-4078
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist