Healthcare Provider Details

I. General information

NPI: 1841885571
Provider Name (Legal Business Name): DONNA J FLETCHER RPH, BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA J KNIERIEM

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 MORDRED LN
AUSTIN TX
78739-1731
US

IV. Provider business mailing address

6009 MORDRED LN
AUSTIN TX
78739-1731
US

V. Phone/Fax

Practice location:
  • Phone: 512-658-8918
  • Fax:
Mailing address:
  • Phone: 512-658-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number32625
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: