Provider Demographics
NPI:1902154164
Name:SCRIVNER, DONNIE JOE (RPH)
Entity Type:Individual
Prefix:
First Name:DONNIE
Middle Name:JOE
Last Name:SCRIVNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9330
Mailing Address - Country:US
Mailing Address - Phone:601-626-8338
Mailing Address - Fax:601-626-8082
Practice Address - Street 1:9155 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39325-9330
Practice Address - Country:US
Practice Address - Phone:601-626-8338
Practice Address - Fax:601-626-8082
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist