Provider Demographics
NPI:1821691676
Name:DOUGHERTYS PHARMACY INC
Entity Type:Organization
Organization Name:DOUGHERTYS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:EDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-818-6813
Mailing Address - Street 1:5959 ROYAL LN STE 515
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3890
Mailing Address - Country:US
Mailing Address - Phone:214-373-5300
Mailing Address - Fax:214-373-5333
Practice Address - Street 1:5959 ROYAL LN STE 515
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3890
Practice Address - Country:US
Practice Address - Phone:214-373-5300
Practice Address - Fax:214-373-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty