Provider Demographics
NPI:1356775811
Name:ESPERSEN, DOUGLAS H (RPH CGP FASCP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
Last Name:ESPERSEN
Suffix:
Gender:M
Credentials:RPH CGP FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1673
Mailing Address - Country:US
Mailing Address - Phone:267-222-2060
Mailing Address - Fax:
Practice Address - Street 1:381 COURTLAND AVE
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1673
Practice Address - Country:US
Practice Address - Phone:267-222-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036373R183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric