Basic Information
| Provider Information | |||||||||
| NPI: | 1649376955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONELENKO | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5118 NW 76TH LANE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523799447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | VA HOSPITAL | ||||||||
| Address2: | 619 SOUTH MARION AVE. | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | PS 22641 | FL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.