Provider Demographics
NPI:1588974471
Name:DOUGHERTY, PATRICK PORTER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PORTER
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 ERICA CT
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7419
Mailing Address - Country:US
Mailing Address - Phone:518-229-8983
Mailing Address - Fax:
Practice Address - Street 1:100 EAST CARROLL ST
Practice Address - Street 2:PENINSULA REGIONAL MEDICAL CENTER
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-912-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist