MEDICARE: DOUG HUMBER 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	1835C0205X	Critical Care Pharmacist	48930	CA

General Provider Information

NPI Number	:	1689212706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUG HUMBER PHARM.D.

Provider Business Mailing Address
First Line	:	9500 GILMAN DRIVE, #0657
Second Line	:	IVY TRAILER ROOM 103
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0657
Country	:	US
Telephone Number	:	858-534-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 GILMAN DRIVE, #0657
Second Line	:	IVY TRAILER ROOM 103
City	:	LA JOLLA
State	:	CA
Zip	:	92093-0657
Country	:	US
Telephone Number	:	858-534-8777
Fax Number	:

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

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	12/19/2019

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