Provider Demographics
NPI:1063702926
Name:DOUGLAS, EDWARD R (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4137
Mailing Address - Country:US
Mailing Address - Phone:843-662-2970
Mailing Address - Fax:843-665-2561
Practice Address - Street 1:1825 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4137
Practice Address - Country:US
Practice Address - Phone:843-662-2970
Practice Address - Fax:843-665-2561
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5809183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy