Provider Demographics
NPI:1235267196
Name:DOUG'S FAMILY PHARMACY
Entity Type:Organization
Organization Name:DOUG'S FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-286-0496
Mailing Address - Street 1:101 DARBY SQ
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9303
Mailing Address - Country:US
Mailing Address - Phone:610-286-0496
Mailing Address - Fax:610-286-6968
Practice Address - Street 1:101 DARBY SQ
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9303
Practice Address - Country:US
Practice Address - Phone:610-286-0496
Practice Address - Fax:610-286-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413739L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010791300002Medicaid
PA0010791300002Medicaid