Provider Demographics
NPI:1861072126
Name:DEGEORGE, DOUGLASS (PHARMD)
Entity type:Individual
Prefix:
First Name:DOUGLASS
Middle Name:
Last Name:DEGEORGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13034 SHRINERS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8250
Mailing Address - Country:US
Mailing Address - Phone:228-392-5355
Mailing Address - Fax:
Practice Address - Street 1:13034 SHRINERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8250
Practice Address - Country:US
Practice Address - Phone:228-392-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSIE-8630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist