Provider Demographics
NPI:1114241528
Name:RANKIN, DOUGLAS WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:RANKIN
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 1:1752 HICKS DR
Mailing Address - Street 2:
Mailing Address - City:LINDLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14858-9682
Mailing Address - Country:US
Mailing Address - Phone:607-523-8343
Mailing Address - Fax:
Practice Address - Street 1:830 COUNTY ROAD 64
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903-9719
Practice Address - Country:US
Practice Address - Phone:607-739-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist