Provider Demographics
NPI:1699283127
Name:SIZEMORE, DONNA DENISE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:DENISE
Last Name:SIZEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 OLD WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-7284
Mailing Address - Country:US
Mailing Address - Phone:423-838-0122
Mailing Address - Fax:
Practice Address - Street 1:3034 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5806
Practice Address - Country:US
Practice Address - Phone:423-775-0703
Practice Address - Fax:423-775-1027
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist