MEDICARE: DAVID DOHERTY

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	25191	TX

General Provider Information

NPI Number	:	1487209094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DOHERTY

Provider Business Mailing Address
First Line	:	2530 S GEORGIA ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-1927
Country	:	US
Telephone Number	:	806-468-9911
Fax Number	:	806-468-6071

Provider Business Practice Location Address
First Line	:	2530 S GEORGIA ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-1927
Country	:	US
Telephone Number	:	806-468-9911
Fax Number	:	806-468-6071

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

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	08/09/2019

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Directions to “ DAVID DOHERTY ” Practice Location

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