Provider Demographics
NPI:1447685649
Name:DOUGLAS, WILLIE LEE (PHARM D)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:LEE
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:MR
Other - First Name:WILL
Other - Middle Name:LEE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692
Mailing Address - Country:US
Mailing Address - Phone:254-694-2249
Mailing Address - Fax:254-694-2249
Practice Address - Street 1:203 E JEFFERSON AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2302
Practice Address - Country:US
Practice Address - Phone:254-694-2249
Practice Address - Fax:254-694-6495
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist