Provider Demographics
NPI:1427729771
Name:DONAHO, ROBERT CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:DONAHO
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 1:1903 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1530
Mailing Address - Country:US
Mailing Address - Phone:217-787-2830
Mailing Address - Fax:217-787-4520
Practice Address - Street 1:1903 W MONROE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1530
Practice Address - Country:US
Practice Address - Phone:217-787-0340
Practice Address - Fax:217-787-4520
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist