Healthcare Provider Details

I. General information

NPI: 1871985044
Provider Name (Legal Business Name): DOUG VAAL PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 MONTGOMERY RD
MONTGOMERY OH
45242-5311
US

IV. Provider business mailing address

9939 MONTGOMERY RD
MONTGOMERY OH
45242
US

V. Phone/Fax

Practice location:
  • Phone: 513-793-1620
  • Fax:
Mailing address:
  • Phone: 513-793-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberOH03-2-15466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: