Provider Demographics
NPI:1588390074
Name:DONOVAN, ANN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SPRUCE ST SE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:MN
Mailing Address - Zip Code:55935-8825
Mailing Address - Country:US
Mailing Address - Phone:507-251-1451
Mailing Address - Fax:
Practice Address - Street 1:136 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965
Practice Address - Country:US
Practice Address - Phone:507-765-2156
Practice Address - Fax:507-765-2115
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1165445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist