Provider Demographics
NPI:1629138581
Name:VANVARK, DONNA L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:VANVARK
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 1:1414 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1002
Mailing Address - Country:US
Mailing Address - Phone:641-628-2446
Mailing Address - Fax:
Practice Address - Street 1:118 SE 9TH ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-2200
Practice Address - Country:US
Practice Address - Phone:641-628-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist