Provider Demographics
NPI:1508690314
Name:FARINELLA, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:FARINELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541343 LEM TURNER RD
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-8544
Mailing Address - Country:US
Mailing Address - Phone:904-614-1354
Mailing Address - Fax:
Practice Address - Street 1:542325 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-6496
Practice Address - Country:US
Practice Address - Phone:904-879-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist