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General NPI Number Information
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NPI Number | 1093854341
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Entity Type | Individual
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Provider Name | KEVIN M. DOHERTY PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 MEMORIAL DR
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City | DENISON
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State | TX
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Zip | 75020-2035
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Country | US
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Telephone | 903-416-4072
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 W BOND ST
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City | DENISON
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State | TX
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Zip | 75020-2106
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Country | US
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Telephone | 903-647-7363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 444185
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License Number State | TX
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