Provider Demographics
NPI:1376132902
Name:DOUGLASS, RICHARD L (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25077 MAIDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1770
Mailing Address - Country:US
Mailing Address - Phone:216-849-3025
Mailing Address - Fax:
Practice Address - Street 1:35279 VINE ST
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3140
Practice Address - Country:US
Practice Address - Phone:440-918-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032181621835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care