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General NPI Number Information
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NPI Number | 1083805261
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Entity Type | Organization
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Legal Business Name | DOUGLAS PHARMACY LLC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 94 W 5TH ST
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City | DOUGLAS
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State | AZ
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Zip | 85607-2851
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Country | US
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Telephone | 520-364-2315
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Fax | 520-364-2318
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Provider Business Mailing Address
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Address Line | PO BOX 597
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City | SAINT DAVID
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State | AZ
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Zip | 85630-0597
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Country | US
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Telephone | 520-240-3936
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Fax | 520-720-4417
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Authorized Official
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Title or Position | OWNER
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Name | GREG SHUMAKER
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Credential |
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Telephone | 520-364-2315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | Y004878
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License Number State | AZ
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