Healthcare Provider Details

I. General information

NPI: 1962764084
Provider Name (Legal Business Name): DOUGLAS S MCCULLOUGH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 HEBRON RD
HEATH OH
43056-1181
US

IV. Provider business mailing address

910 HEBRON RD
HEATH OH
43056-1181
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-3693
  • Fax: 740-522-3941
Mailing address:
  • Phone: 740-522-3696
  • Fax: 740-522-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03319743
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: