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General NPI Number Information
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NPI Number | 1376552687
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Entity Type | Individual
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Provider Name | DONALD WAYNE NETTLETON R.PH.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 353 FAIRMONT BLVD RAPID CITY REGIONAL HOSPITAL PHARMACY
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City | RAPID CITY
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State | SD
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Zip | 57701-7375
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Country | US
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Telephone | 605-719-8182
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Fax | 605-719-1003
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Provider Business Mailing Address
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Address Line | 353 FAIRMONT BLVD RAPID CITY REGIONAL HOSPITAL CANCER CARE INSTITUTE
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City | RAPID CITY
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State | SD
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Zip | 57701-7375
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Country | US
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Telephone | 605-719-8182
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Fax | 605-719-1003
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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 | R4323
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License Number State | SD
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