Healthcare Provider Details

I. General information

NPI: 1710055835
Provider Name (Legal Business Name): MS. BARBARA K DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

2230 W RIVERSIDE AVE APT 202
SPOKANE WA
99201-1442
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3244
  • Fax:
Mailing address:
  • Phone: 509-953-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010229
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: