Jacob Dugan, PHARM D.
Individual provider Active NPI Pharmacist · Fredonia, KS
NPI 1013403633 · NPPES record last updated Jul 6, 2018
Key facts
- NPI
- 1013403633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 1-106222 (KS)
- Practice address
- 628 Madison St
Fredonia, KS 66736-1338 - Phone
- (620) 378-4422
- NPI assigned
- Jul 6, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-106222 | KS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Council Grove Pharmacy Inc | Current | Accepting new patients | |
| Council Grove Pharmacy Inc | Current | Accepting new patients | |
| Fredonia Pharmacy Inc | Past | Accepting new patients | |
| Fredonia Pharmacy Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1-106222 | KS | Yes |
Addresses
Primary practice location
628 Madison St
Fredonia, KS 66736-1338
Mailing address
628 Madison St
Fredonia, KS 66736-1338
Phone (620) 378-4422
Other providers in Fredonia, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.