Organization
JAN DOUGLASS
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
505 W UNIVERSITY AVE, SUITE H, GEORGETOWN, TX 78626-6643
(512) 863-2297
(512) 863-2975
Mailing address
505 W UNIVERSITY AVE, SUITE H, GEORGETOWN, TX 78626-6643
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
20963
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142947
—
TX
01
—
4572283
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/27/2007
Last updated
03/07/2023
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