Provider Demographics
NPI:1144356270
Name:GUDENAS, K. DONALDAS
Entity type:Individual
Prefix:DR
First Name:K.
Middle Name:DONALDAS
Last Name:GUDENAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:K.
Other - Middle Name:DONALDAS
Other - Last Name:GUDENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, CDM
Mailing Address - Street 1:5900 BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-0907
Mailing Address - Country:US
Mailing Address - Phone:440-257-1583
Mailing Address - Fax:
Practice Address - Street 1:30500 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3600
Practice Address - Country:US
Practice Address - Phone:440-943-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-15585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist