MEDICARE: THERON DOUGLAS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS53880	FL

General Provider Information

NPI Number	:	1235589888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERON DOUGLAS PHARMD

Provider Business Mailing Address
First Line	:	2010 SW COLLEGE RD
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34471-1620
Country	:	US
Telephone Number	:	352-368-1886
Fax Number	:

Provider Business Practice Location Address
First Line	:	4459 WHISPERING INLET DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1136
Country	:	US
Telephone Number	:	352-368-1886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	07/26/2016

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