Provider Demographics
NPI:1760085161
Name:AITOUMEZIANE, DONNA F (RPH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:F
Last Name:AITOUMEZIANE
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 1:2252 N 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2842
Mailing Address - Country:US
Mailing Address - Phone:479-621-9188
Mailing Address - Fax:
Practice Address - Street 1:2252 N 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2842
Practice Address - Country:US
Practice Address - Phone:479-621-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14493183500000X
FLPS21320183500000X
ARPD10873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist