Provider Demographics
NPI:1154608511
Name:HUTTON, DONALD II (RPH)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:HUTTON
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4595
Mailing Address - Country:US
Mailing Address - Phone:217-235-3126
Mailing Address - Fax:217-234-3675
Practice Address - Street 1:212 S LOGAN AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4595
Practice Address - Country:US
Practice Address - Phone:217-235-3126
Practice Address - Fax:217-234-3675
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-033776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist