Organization
DOUGLAS PHARMACY LLC
Active
Other names
DOUGLAS HEALTH MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREG SHUMAKER (OWNER)
(520) 364-2315
Entity
Organization
Contact information
Practice address
94 W 5TH ST, DOUGLAS, AZ 85607-2851
(520) 364-2315
(520) 364-2318
Mailing address
PO BOX 597, SAINT DAVID, AZ 85630-0597
(520) 240-3936
(520) 720-4417
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
Y004878
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0354895
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
290702
—
AZ
Enumeration date
08/05/2007
Last updated
08/29/2011
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