Provider Demographics
NPI:1457676728
Name:JOSEPHSON, DOUGLAS CARL (RPH, FASCP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CARL
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:RPH, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4382 14 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7838
Mailing Address - Country:US
Mailing Address - Phone:616-785-2100
Mailing Address - Fax:616-785-2139
Practice Address - Street 1:4382 14 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7838
Practice Address - Country:US
Practice Address - Phone:616-785-2100
Practice Address - Fax:616-785-2139
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020264271835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric