Provider Demographics
NPI:1811317258
Name:DOUGLAS, GEORGIANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GEORGIANNE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 E WT HARRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-2402
Mailing Address - Country:US
Mailing Address - Phone:704-916-1892
Mailing Address - Fax:
Practice Address - Street 1:8800 E WT HARRIS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-2402
Practice Address - Country:US
Practice Address - Phone:704-916-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12815183500000X
NC20490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20490OtherPHARMACIST LICENSE
SC12815OtherPHARMACIST LICENSE