Provider Demographics
NPI:1134267958
Name:ROBERTS, DONNA LU (RPH)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LU
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ACKLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50601-1644
Mailing Address - Country:US
Mailing Address - Phone:641-847-6931
Mailing Address - Fax:641-847-2332
Practice Address - Street 1:722 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-1538
Practice Address - Country:US
Practice Address - Phone:641-847-2585
Practice Address - Fax:641-847-2332
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist