Provider Demographics
NPI:1942508536
Name:FRASER, DOUGLAS LEE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LEE
Last Name:FRASER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38169 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3033
Mailing Address - Country:US
Mailing Address - Phone:302-436-9226
Mailing Address - Fax:
Practice Address - Street 1:38169 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3033
Practice Address - Country:US
Practice Address - Phone:302-436-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist