Healthcare Provider Details

I. General information

NPI: 1881151199
Provider Name (Legal Business Name): BLAKE DOUGLAS ENFINGER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 STANFORD RD
DOTHAN AL
36305-1917
US

IV. Provider business mailing address

1620 ROSS CLARK CIR
DOTHAN AL
36301-5439
US

V. Phone/Fax

Practice location:
  • Phone: 334-798-7929
  • Fax:
Mailing address:
  • Phone: 334-673-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20728
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: