Provider Demographics
NPI:1437158250
Name:DEHART, DONALD WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WILLIAM
Last Name:DEHART
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 DUNLOP LN STE 110
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6072
Mailing Address - Country:US
Mailing Address - Phone:931-278-6422
Mailing Address - Fax:931-278-6423
Practice Address - Street 1:2130 W POPLAR AVE STE 104
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0615
Practice Address - Country:US
Practice Address - Phone:901-542-8001
Practice Address - Fax:901-542-8002
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13919183500000X
KY022092183500000X
TN41623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY022092OtherSTATE PHARMACY LICENSE #
TN41623OtherSTATE PHARMACY LICENSE #
AL13919OtherSTATE PHARMACY LICENSE #