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General NPI Number Information
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NPI Number | 1417189291
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Entity Type | Individual
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Provider Name | DOUGLAS FASNACHT PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 22920 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33549-6931
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Country | US
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Telephone | 813-949-7872
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Fax | 813-949-6690
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Provider Business Mailing Address
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Address Line | 22920 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33549-6931
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Country | US
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Telephone | 813-949-7872
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Fax | 813-949-6690
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 39620
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License Number State | FL
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