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General NPI Number Information
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NPI Number | 1134466196
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Entity Type | Individual
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Provider Name | DONALD RAY PEARSON
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Gender | Male
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 6900 DANIELS PKWY STE 19
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City | FORT MYERS
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State | FL
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Zip | 33912-1586
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Country | US
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Telephone | 239-768-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 13609 ADMIRAL CT
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City | FORT MYERS
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State | FL
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Zip | 33912-5628
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Country | US
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Telephone | 239-561-5730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS25973
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License Number State | FL
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