Provider Demographics
NPI:1457792863
Name:O'DONNELL, DONNA M
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LITTLE FLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:NESQUEHONING
Mailing Address - State:PA
Mailing Address - Zip Code:18240-1016
Mailing Address - Country:US
Mailing Address - Phone:570-669-9193
Mailing Address - Fax:
Practice Address - Street 1:241 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1514
Practice Address - Country:US
Practice Address - Phone:610-377-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037145L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist