MEDICARE: DR. MICHELLE LYNETTE DOUGLASS PHARM.D.

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	56851	TX

General Provider Information

NPI Number	:	1639544679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE LYNETTE DOUGLASS PHARM.D.

Provider Business Mailing Address
First Line	:	10102 BOXING PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3244
Country	:	US
Telephone Number	:	214-205-6426
Fax Number	:

Provider Business Practice Location Address
First Line	:	10102 BOXING PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3244
Country	:	US
Telephone Number	:	214-205-6426
Fax Number	:

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

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	12/02/2015

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