Provider Demographics
NPI:1265561302
Name:HEROLD, DONNETTA L (RPH)
Entity type:Individual
Prefix:
First Name:DONNETTA
Middle Name:L
Last Name:HEROLD
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 1:4306 COLONY SQ
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4298
Mailing Address - Country:US
Mailing Address - Phone:706-868-9143
Mailing Address - Fax:
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3188
Practice Address - Country:US
Practice Address - Phone:706-854-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4993183500000X
GA17157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist