Healthcare Provider Details

I. General information

NPI: 1629290218
Provider Name (Legal Business Name): DOUGLAS JOSEPH DONOVALL JR. PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FIRST AVE SOUTH
CLENDENIN WV
25045
US

IV. Provider business mailing address

4 CHIMNEY HILL LANE
CHARLESTON WV
25311
US

V. Phone/Fax

Practice location:
  • Phone: 304-548-6593
  • Fax:
Mailing address:
  • Phone: 304-545-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0006770
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: