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General NPI Number Information
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NPI Number | 1881151199
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Entity Type | Individual
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Provider Name | BLAKE DOUGLAS ENFINGER PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 1315 STANFORD RD
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City | DOTHAN
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State | AL
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Zip | 36305-1917
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Country | US
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Telephone | 334-798-7929
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 ROSS CLARK CIR
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City | DOTHAN
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State | AL
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Zip | 36301-5439
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Country | US
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Telephone | 334-673-1200
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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 | 20728
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License Number State | AL
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