Provider Demographics
NPI:1174974943
Name:MOTT, DONNA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:MOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:MACDOUGALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3043
Mailing Address - Country:US
Mailing Address - Phone:315-463-5229
Mailing Address - Fax:
Practice Address - Street 1:3120 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-3043
Practice Address - Country:US
Practice Address - Phone:315-463-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058123-I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist