Provider Demographics
NPI:1386771947
Name:DONAT, PATRICK J (RPH)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:DONAT
Suffix:
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:PO BOX 1801
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1801
Mailing Address - Country:US
Mailing Address - Phone:208-682-3920
Mailing Address - Fax:208-682-3939
Practice Address - Street 1:504 NORTH DIVISION AVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:ID
Practice Address - Zip Code:83850
Practice Address - Country:US
Practice Address - Phone:208-682-3920
Practice Address - Fax:208-682-3939
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP5220OtherPHARMACIST LICENSE #