Healthcare Provider Details

I. General information

NPI: 1710037882
Provider Name (Legal Business Name): DOUGLAS L FRANK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 MICHIGAN AVENUE
OROFINO ID
83544
US

IV. Provider business mailing address

PO BOX 1532
OROFINO ID
83544-1532
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-5727
  • Fax: 208-476-4045
Mailing address:
  • Phone: 208-476-3778
  • Fax: 208-476-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4949
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: