Provider Demographics
NPI:1891209151
Name:FAUCHER, DOUGLAS MARTIN (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:FAUCHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 CENTER ST UNIT 127
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3822
Mailing Address - Country:US
Mailing Address - Phone:619-208-4841
Mailing Address - Fax:
Practice Address - Street 1:384 H ST # 100
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5513
Practice Address - Country:US
Practice Address - Phone:619-781-8177
Practice Address - Fax:619-623-3435
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2018-11-15
Deactivation Date:2018-06-09
Deactivation Code:
Reactivation Date:2018-11-15
Provider Licenses
StateLicense IDTaxonomies
CA37890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist