Basic Information
Provider Information
NPI: 1003154220
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HATFIELD
FirstName: DONALD
MiddleName: RAY
NamePrefix: MR.
NameSuffix:  
Credential: R.PH.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5200 NW 43RD ST
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326064484
CountryCode: US
TelephoneNumber: 3523760585
FaxNumber: 3523751290
Practice Location
Address1: 5200 NW 43RD ST
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326064484
CountryCode: US
TelephoneNumber: 3523760585
FaxNumber: 3523751290
Other Information
ProviderEnumerationDate: 01/23/2013
LastUpdateDate: 01/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1835P0018X4024WVN Pharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
1835P0018X20029FLY Pharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

No ID Information.


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