Provider Demographics
NPI:1659675411
Name:DOUGHTY, JENNY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:L
Other - Last Name:KLUCHUROSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 EAST BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5802
Mailing Address - Country:US
Mailing Address - Phone:704-910-4288
Mailing Address - Fax:704-910-4294
Practice Address - Street 1:1300 EAST BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5802
Practice Address - Country:US
Practice Address - Phone:704-910-4288
Practice Address - Fax:704-910-4294
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist