Provider Demographics
NPI:1851386650
Name:HUTSON, DONNA L (RPH)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:L
Last Name:HUTSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:LACKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD RPH
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-1684
Mailing Address - Country:US
Mailing Address - Phone:678-388-9682
Mailing Address - Fax:678-388-9682
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-538-7559
Practice Address - Fax:770-531-3873
Is Sole Proprietor?:No
Enumeration Date:2005-09-18
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist