Provider Demographics
NPI:1972896371
Name:FAROLAN, DOUGLAS D
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:FAROLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:DEZABALLARPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6716 SAVANNAH FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312
Mailing Address - Country:US
Mailing Address - Phone:661-213-4285
Mailing Address - Fax:
Practice Address - Street 1:6716 SAVANNAH FALLS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-1878
Practice Address - Country:US
Practice Address - Phone:661-213-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 32291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist