Healthcare Provider Details

I. General information

NPI: 1043595382
Provider Name (Legal Business Name): DOUGLAS A. HANCOCK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINDEN ST STE 1
BIG RAPIDS MI
49307-1880
US

IV. Provider business mailing address

15180 OAKWOOD DR
BIG RAPIDS MI
49307-9255
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3200
  • Fax:
Mailing address:
  • Phone: 231-592-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411234
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: