Healthcare Provider Details

I. General information

NPI: 1952684029
Provider Name (Legal Business Name): DEBORAH ANN DYSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2011
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 N JEFFERSON ST
HUNTINGTON IN
46750-1343
US

IV. Provider business mailing address

8352 N 900 W
HUNTINGTON IN
46750-8840
US

V. Phone/Fax

Practice location:
  • Phone: 260-358-0014
  • Fax:
Mailing address:
  • Phone: 260-344-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016127A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: