Provider Demographics
NPI:1104922418
Name:DOUGALAS, ANTHONY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DOUGALAS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:DOUGALAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:69 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-1553
Mailing Address - Country:US
Mailing Address - Phone:570-735-5114
Mailing Address - Fax:
Practice Address - Street 1:69 N MARKET ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1553
Practice Address - Country:US
Practice Address - Phone:570-735-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412490L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist