Provider Demographics
NPI:1639662182
Name:SUTTON, DONALD ROYCE (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROYCE
Last Name:SUTTON
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 1:90 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-4004
Mailing Address - Country:US
Mailing Address - Phone:928-853-9616
Mailing Address - Fax:
Practice Address - Street 1:90 6TH ST SW
Practice Address - Street 2:
Practice Address - City:BEACH
Practice Address - State:ND
Practice Address - Zip Code:58621-4004
Practice Address - Country:US
Practice Address - Phone:928-853-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046676183500000X
AZ6522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist