Provider Demographics
NPI:1538761200
Name:MCDOUGAL, KEBRA RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEBRA
Middle Name:RENEE
Last Name:MCDOUGAL
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 1:2051 W CUMBERLAND RD APT 712
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7853
Mailing Address - Country:US
Mailing Address - Phone:903-316-3000
Mailing Address - Fax:
Practice Address - Street 1:110 S SW LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6508
Practice Address - Country:US
Practice Address - Phone:903-526-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist