Provider Demographics
NPI:1841461142
Name:DOUGLAS, PATREASE DENISE
Entity type:Individual
Prefix:MRS
First Name:PATREASE
Middle Name:DENISE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATREASE
Other - Middle Name:DENISE
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5171 SAM JARED DR BLDG 112
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1382
Mailing Address - Country:US
Mailing Address - Phone:615-904-9727
Mailing Address - Fax:615-904-9728
Practice Address - Street 1:5171 SAM JARED DR BLDG 112
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1382
Practice Address - Country:US
Practice Address - Phone:615-904-9727
Practice Address - Fax:615-904-9728
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist