Healthcare Provider Details

I. General information

NPI: 1477703064
Provider Name (Legal Business Name): DANA KAY WITHROW PHARMACY TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA KAY YOUNG

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 HIGHWAY 14 WEST
CHRISTOPHER IL
62822
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-724-2436
  • Fax:
Mailing address:
  • Phone: 618-724-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049186155
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: