Provider Demographics
NPI:1710209671
Name:GANOE, DONALD (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:GANOE
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 1:1403 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1099
Mailing Address - Country:US
Mailing Address - Phone:218-739-2670
Mailing Address - Fax:218-739-0806
Practice Address - Street 1:1403 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1099
Practice Address - Country:US
Practice Address - Phone:218-739-2670
Practice Address - Fax:218-739-0806
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist