Provider Demographics
NPI:1770863516
Name:GENTRUP, DONALD THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:THOMAS
Last Name:GENTRUP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-1722
Mailing Address - Country:US
Mailing Address - Phone:910-429-8675
Mailing Address - Fax:
Practice Address - Street 1:3030 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1722
Practice Address - Country:US
Practice Address - Phone:910-429-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210648183500000X
NC21766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist