Healthcare Provider Details

I. General information

NPI: 1619255924
Provider Name (Legal Business Name): DOUGLAS FREDERICK AGNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E MAIN ST
CHERRYVILLE NC
28021-3411
US

IV. Provider business mailing address

302 E MAIN ST
CHERRYVILLE NC
28021-3411
US

V. Phone/Fax

Practice location:
  • Phone: 704-445-2668
  • Fax: 704-445-2133
Mailing address:
  • Phone: 704-445-2668
  • Fax: 704-445-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7646
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: