Healthcare Provider Details

I. General information

NPI: 1194320564
Provider Name (Legal Business Name): MICHAEL S DONOHUE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 W OSBORN RD APT 2
PHOENIX AZ
85015-5954
US

IV. Provider business mailing address

1519 W OSBORN RD APT 2
PHOENIX AZ
85015-5954
US

V. Phone/Fax

Practice location:
  • Phone: 602-799-5834
  • Fax: 866-549-7809
Mailing address:
  • Phone: 602-799-5834
  • Fax: 866-549-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number008320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: