Healthcare Provider Details

I. General information

NPI: 1578612628
Provider Name (Legal Business Name): DONNA J GORR R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 S OCEANA DR
NEW ERA MI
49446-9781
US

IV. Provider business mailing address

411 E RIVER ST
WHITEHALL MI
49461-1146
US

V. Phone/Fax

Practice location:
  • Phone: 231-861-6900
  • Fax: 231-861-7177
Mailing address:
  • Phone: 586-242-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: