Provider Demographics
NPI:1811295330
Name:EZELL, DONALD RAY (RPH)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:EZELL
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 1:5320 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-9006
Mailing Address - Country:US
Mailing Address - Phone:256-760-9548
Mailing Address - Fax:
Practice Address - Street 1:2403 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2877
Practice Address - Country:US
Practice Address - Phone:256-766-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10302183500000X
TN8720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10302OtherPHARMACY LICENSE