Provider Demographics
NPI:1548684491
Name:RUTHERFORD, DOUGLAS WAYNE I (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:RUTHERFORD
Suffix:I
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4026
Mailing Address - Country:US
Mailing Address - Phone:806-273-1433
Mailing Address - Fax:806-273-3244
Practice Address - Street 1:230 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4026
Practice Address - Country:US
Practice Address - Phone:806-273-1433
Practice Address - Fax:806-273-2053
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist