Provider Demographics
NPI:1750603205
Name:DOUGLAS, JANINE (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WINGATE
Mailing Address - State:NC
Mailing Address - Zip Code:28174
Mailing Address - Country:US
Mailing Address - Phone:704-233-8974
Mailing Address - Fax:
Practice Address - Street 1:515 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174
Practice Address - Country:US
Practice Address - Phone:704-233-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054306-1183500000X
FLPS48569183500000X
OHRPH.03230682-2183500000X
CTPCT.00122491835P0018X
NC247931835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist