Healthcare Provider Details

I. General information

NPI: 1992139497
Provider Name (Legal Business Name): MICHAEL DENNIS WEBSTER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US 491 N
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO BOX 160 PHARMACY
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6001
  • Fax: 505-368-6260
Mailing address:
  • Phone: 505-368-6001
  • Fax: 505-368-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.296474
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: