Provider Demographics
NPI:1376668368
Name:CULLEY, DONNA B (RPH)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:B
Last Name:CULLEY
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:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:CHILMARK
Mailing Address - State:MA
Mailing Address - Zip Code:02535-0680
Mailing Address - Country:US
Mailing Address - Phone:508-645-3210
Mailing Address - Fax:508-645-2774
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 005
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist