=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114241528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS WILLIAM RANKIN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 COUNTY ROAD 64
-----------------------------------------------------
City | ELMIRA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14903-9719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-739-0495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1752 HICKS DR
-----------------------------------------------------
City | LINDLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14858-9682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-523-8343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 046416
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------