Provider Demographics
NPI:1457639130
Name:DONALDSON, MARY ELLEN (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:DONALDSON
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 1:26610 YNEZ RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4697
Mailing Address - Country:US
Mailing Address - Phone:951-719-2002
Mailing Address - Fax:
Practice Address - Street 1:26610 YNEZ RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4697
Practice Address - Country:US
Practice Address - Phone:951-719-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT385461835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist