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There are many situations in which the use of an honorific is acceptable.In a different thread a student has shared a letter from the college president, a pharmacist. The letter is signed with the title "Dr.". The prefix is also used below the name without any mention that the individual is Pharm.D.
The use of the MD in any ambiguous or clinical setting would not be.
Even PhDs (who are otherwise called "Dr." at the medical school in a classroom setting) may not be addressed as "Dr." in our hospital in the earshot of patients or their families.