=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255983300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONN CHARLES SPERRY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2019
-----------------------------------------------------
Last Update Date | 07/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 W MAIN ST
-----------------------------------------------------
City | RIPON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95366-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-599-6090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 W MAIN ST
-----------------------------------------------------
City | RIPON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95366-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-599-6090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 031348
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------