Provider Demographics
NPI:1952983678
Name:BRINDISI, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:BRINDISI
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 1:99 MASONIC DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2573
Mailing Address - Country:US
Mailing Address - Phone:717-877-4419
Mailing Address - Fax:717-361-3908
Practice Address - Street 1:99 MASONIC DR STE 103
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2573
Practice Address - Country:US
Practice Address - Phone:717-877-4419
Practice Address - Fax:717-361-3908
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041663L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP041663LOtherSBOP