Provider Demographics
NPI:1972546679
Name:FUNK, DOUGLAS LLOYD (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LLOYD
Last Name:FUNK
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 1:1020 ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901
Mailing Address - Country:US
Mailing Address - Phone:785-243-4414
Mailing Address - Fax:785-243-1827
Practice Address - Street 1:4921 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2090
Practice Address - Country:US
Practice Address - Phone:785-830-0100
Practice Address - Fax:785-830-0115
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist