Doctor Name: | MS. DONA MARIE IDT |
NPI Number: | 1033509500 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPHT |
License Number: | 590107010293680 |
Business Practice Address: | 1250 N Port Washington Rd Grafton, WI - 530249315 |
Business Phone Number: | 2623756738 |
Business Fax Number: | 2626189138 |
Mailing Address: | 1250 N Port Washington Rd, GRAFTON |
State: | WI |
Postal Code: | 530249315 |
Phone Number: | 2623756738 |
Fax Number: | 2626189138 |
NPI Enumeration Date: | 02/04/2015 |
NPI Last Update Date: | 02/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 183700000X |
License Number: | 590107010293680 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Pharmacy Service Providers |
Taxonomy Classification: | Pharmacy Technician |
Taxonomy Specialization: | |
Taxonomy Definition: | A person who works under the direct supervision of a licensed pharmacist and performs many pharmacy-related functions that do not require the professional judgment of a pharmacist. |