Provider Demographics
NPI:1841885571
Name:FLETCHER, DONNA J (RPH, BCGP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:KNIERIEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6009 MORDRED LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1731
Mailing Address - Country:US
Mailing Address - Phone:512-658-8918
Mailing Address - Fax:
Practice Address - Street 1:6009 MORDRED LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1731
Practice Address - Country:US
Practice Address - Phone:512-658-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326251835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric