Provider Demographics
NPI:1912324922
Name:BERRY, DOUGLAS ALLAN
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLAN
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9271
Mailing Address - Country:US
Mailing Address - Phone:740-938-4130
Mailing Address - Fax:740-938-4131
Practice Address - Street 1:1860 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-9271
Practice Address - Country:US
Practice Address - Phone:740-938-4130
Practice Address - Fax:740-938-4131
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216365183500000X
FL19050183500000X
GA011684183500000X
NY042581183500000X
WI1487740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA011684OtherPHARMACIST
WI1487740OtherPHARMACIST
FLPS19050OtherPHARMACIST
NY042581OtherPHARMACIST
OH03216365OtherPHARMACIST