Provider Demographics
NPI:1891479259
Name:DOUGLAS, LAQUITA DONATTO (RPH)
Entity Type:Individual
Prefix:
First Name:LAQUITA
Middle Name:DONATTO
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 CULLEN BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1665
Mailing Address - Country:US
Mailing Address - Phone:346-286-3250
Mailing Address - Fax:
Practice Address - Street 1:5737 CULLEN BLVD # 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1665
Practice Address - Country:US
Practice Address - Phone:346-286-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22560183500000X
TX31465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist