MEDICARE: MR. JEFFREY ALAN DONNELLY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8434	AZ

General Provider Information

NPI Number	:	1992727192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY ALAN DONNELLY RPH

Provider Business Mailing Address
First Line	:	2319 W LOBO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-6445
Country	:	US
Telephone Number	:	480-766-2340
Fax Number	:	480-831-0611

Provider Business Practice Location Address
First Line	:	1920 W BROADWAY RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-1127
Country	:	US
Telephone Number	:	480-833-0731
Fax Number	:	480-835-9167

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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