Provider Demographics
NPI:1659360535
Name:SMALL, DAVID O (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:O
Last Name:SMALL
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:23 DAFFODIL LN
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-6014
Mailing Address - Country:US
Mailing Address - Phone:508-221-1733
Mailing Address - Fax:508-228-1375
Practice Address - Street 1:122 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4003
Practice Address - Country:US
Practice Address - Phone:508-228-6400
Practice Address - Fax:508-228-1375
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA20099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist