MEDICARE: DR. AMY MICHELLE 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	20500	AL

General Provider Information

NPI Number	:	1245719103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY MICHELLE DOUGLAS PHARMD

Provider Business Mailing Address
First Line	:	9917A SPANISH FORT BLVD
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5603
Country	:	US
Telephone Number	:	251-626-3113
Fax Number	:	251-800-3276

Provider Business Practice Location Address
First Line	:	9917A SPANISH FORT BLVD
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-5603
Country	:	US
Telephone Number	:	251-626-3113
Fax Number	:

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

Provider Enumeration Date	:	08/11/2018
Last Update Date	:	11/25/2020

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