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General NPI Number Information
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NPI Number | 1649244153
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Entity Type | Individual
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Provider Name | DUSTIN T DOUGLAS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 09/21/2024
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Provider Practice Location Address
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Address Line | 19 MEDICAL LOOP STE 2
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City | WHITLEY CITY
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State | KY
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Zip | 42653-4382
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Country | US
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Telephone | 606-376-5043
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Fax | 606-376-5466
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Provider Business Mailing Address
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Address Line | 458 ASHLEY LN
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City | ONEIDA
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State | TN
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Zip | 37841-6060
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Country | US
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Telephone | 423-286-7825
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0036725
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 36725
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 016194
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License Number State | KY
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