Provider Demographics
NPI:1558658682
Name:DOUGLAS, DAMON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 MORRIS AVE
Mailing Address - Street 2:SUITE 1348
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7154
Mailing Address - Country:US
Mailing Address - Phone:410-317-7463
Mailing Address - Fax:
Practice Address - Street 1:1070 MORRIS AVE
Practice Address - Street 2:SUITE 1348
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7154
Practice Address - Country:US
Practice Address - Phone:410-317-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60421633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist