Provider Demographics
NPI:1770121931
Name:PRICE, DONALD LEE
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LEE
Last Name:PRICE
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 1:13221 SHERBURNE CIR APT 601
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-3465
Mailing Address - Country:US
Mailing Address - Phone:239-390-0421
Mailing Address - Fax:
Practice Address - Street 1:13221 SHERBURNE CIR APT 601
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-3465
Practice Address - Country:US
Practice Address - Phone:239-390-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist