Provider Demographics
NPI:1679726087
Name:DOUGHTY, GLORIA HARTMAN (RPH (PHARMACIST))
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:HARTMAN
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:RPH (PHARMACIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2638
Mailing Address - Country:US
Mailing Address - Phone:859-277-0664
Mailing Address - Fax:
Practice Address - Street 1:424 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2638
Practice Address - Country:US
Practice Address - Phone:859-277-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist