Provider Demographics
NPI:1720112279
Name:DOUBEK, DONALD JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:DOUBEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 W WYANDOT DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1754
Mailing Address - Country:US
Mailing Address - Phone:708-597-3376
Mailing Address - Fax:
Practice Address - Street 1:11350 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-2830
Practice Address - Country:US
Practice Address - Phone:708-293-1122
Practice Address - Fax:708-293-1144
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist