Provider Demographics
NPI:1639544679
Name:DOUGLASS, MICHELLE LYNETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNETTE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 BOXING PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3244
Mailing Address - Country:US
Mailing Address - Phone:214-205-6426
Mailing Address - Fax:
Practice Address - Street 1:10102 BOXING PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3244
Practice Address - Country:US
Practice Address - Phone:214-205-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist