MEDICARE: MRS. DONNA ARDOIN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	38471	TX

General Provider Information

NPI Number	:	1215542097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA ARDOIN RPH

Provider Business Mailing Address
First Line	:	12025 DISHMAN RD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77713-3831
Country	:	US
Telephone Number	:	409-658-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 HIGHWAY 105 E
Second Line	:
City	:	SOUR LAKE
State	:	TX
Zip	:	77659-7783
Country	:	US
Telephone Number	:	409-287-3525
Fax Number	:	409-287-2295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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Directions to “ MRS. DONNA ARDOIN RPH” Practice Location

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