Provider Demographics
NPI:1639201049
Name:MATHIS, DONALD J (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:J
Last Name:MATHIS
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:3006 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5753
Mailing Address - Country:US
Mailing Address - Phone:904-731-2439
Mailing Address - Fax:
Practice Address - Street 1:8560 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5997
Practice Address - Country:US
Practice Address - Phone:904-779-7700
Practice Address - Fax:904-777-3054
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL34011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist