Provider Demographics
NPI:1912242892
Name:DONNELLY, DEANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:PAULEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5000 OLD BUNCOMBE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-8208
Mailing Address - Country:US
Mailing Address - Phone:864-246-1190
Mailing Address - Fax:
Practice Address - Street 1:5000 OLD BUNCOMBE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-8208
Practice Address - Country:US
Practice Address - Phone:864-246-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist