Jan Douglass

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

JAN DOUGLASS

Practice address

505 W University Ave
Suite H
Georgetown, TX 78626-6643

Phone

(512) 863-2297

Fax

(512) 863-2975

NPI assigned

Feb 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dena Ferman

Title

Third Party Plan Coordinator

Phone

(314) 993-6000

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MEDICINE SHOPPE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1174659585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W UNIVERSITY AVE",
            "address_2": "SUITE H",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786266643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W UNIVERSITY AVE",
            "address_2": "SUITE H",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786266643",
            "telephone_number": "512-863-2297",
            "fax_number": "512-863-2975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAN DOUGLASS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "FERMAN",
        "authorized_official_first_name": "DENA",
        "authorized_official_title_or_position": "THIRD PARTY PLAN COORDINATOR",
        "authorized_official_telephone_number": "314-993-6000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "20963",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142947",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4572283",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melora Jean Jacober, PSY.D.
• Jacqueline Kozak
• Samantha Jai Jaekel, M.S., CF-SLP
• Christopher Earl Jaisingh, FNP-C
• James B Thompson MD PA
• Mollie Melinda Jan, D.O.
• Julie Jaworski
• Mark Lee Jayawant, M.D.
• Alexa Jazmin, PA-C
• Joseph P Jeanette II, DO

• Community/Retail Pharmacy in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.