Healthcare Provider Details

I. General information

NPI: 1487781274
Provider Name (Legal Business Name): DOUGLAS GREGORY DAOUST R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 N CLINTON ST
DEFIANCE OH
43512-1609
US

IV. Provider business mailing address

1378 IRONWOOD CT
DEFIANCE OH
43512-8544
US

V. Phone/Fax

Practice location:
  • Phone: 419-782-0155
  • Fax:
Mailing address:
  • Phone: 419-784-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-12325
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: