Healthcare Provider Details

I. General information

NPI: 1689620007
Provider Name (Legal Business Name): DONNA B DYER DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 KENTON ST SUITE 1-E
HOPKINSVILLE KY
42240-1981
US

IV. Provider business mailing address

2485 ROLLOW LN
CLARKSVILLE TN
37043-1500
US

V. Phone/Fax

Practice location:
  • Phone: 270-887-0348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number013008
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberC-5757
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: