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General NPI Number Information
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NPI Number | 1811855844
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Entity Type | Individual
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Provider Name | CLINTON DOUGL;AS III
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Gender | Male
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 111 N WASHINGTON ST
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City | OWOSSO
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State | MI
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Zip | 48867-2819
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Country | US
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Telephone | 989-725-1344
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 BRITTON RD LOT 345
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City | PERRY
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State | MI
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Zip | 48872-9724
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Country | US
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Telephone | 517-944-1943
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5303011270
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License Number State | MI
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