Provider Demographics
NPI:1033499686
Name:DOUGLAS, JANELLE LANEE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:LANEE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8131
Mailing Address - Country:US
Mailing Address - Phone:479-442-4756
Mailing Address - Fax:479-442-4773
Practice Address - Street 1:4007 N SHILOH DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5300
Practice Address - Country:US
Practice Address - Phone:479-442-4756
Practice Address - Fax:479-442-4773
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11151183500000X
OK14563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist