Provider Demographics
NPI:1689212706
Name:HUMBER, DOUG (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:HUMBER
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 1:9500 GILMAN DRIVE, #0657
Mailing Address - Street 2:IVY TRAILER ROOM 103
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0657
Mailing Address - Country:US
Mailing Address - Phone:858-534-8777
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DRIVE, #0657
Practice Address - Street 2:IVY TRAILER ROOM 103
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0657
Practice Address - Country:US
Practice Address - Phone:858-534-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489301835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care