Healthcare Provider Details

I. General information

NPI: 1649376955
Provider Name (Legal Business Name): SCOTT G DONELENKO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA HOSPITAL 619 SOUTH MARION AVE.
LAKE CITY FL
32025
US

IV. Provider business mailing address

5118 NW 76TH LANE
GAINESVILLE FL
32653
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3016
  • Fax:
Mailing address:
  • Phone: 352-379-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS 22641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: