Provider Demographics
NPI:1881290096
Name:WHOLLEY, DONNA ELAYNE (RPH)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ELAYNE
Last Name:WHOLLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1471
Mailing Address - Country:US
Mailing Address - Phone:781-596-0224
Mailing Address - Fax:781-596-2311
Practice Address - Street 1:450 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1471
Practice Address - Country:US
Practice Address - Phone:781-596-0224
Practice Address - Fax:781-596-2311
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist