Provider Demographics
NPI:1548544661
Name:ALI, DONNA MAE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MAE
Last Name:ALI
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 1:6495 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-5202
Mailing Address - Country:US
Mailing Address - Phone:618-687-3478
Mailing Address - Fax:
Practice Address - Street 1:6495 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-5202
Practice Address - Country:US
Practice Address - Phone:618-687-3478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293074183500000X
KY013756183500000X
MO2009008800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist