Healthcare Provider Details

I. General information

NPI: 1033396270
Provider Name (Legal Business Name): DAWN DEWEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GARLAND LN
GREENVILLE NY
12083-3410
US

IV. Provider business mailing address

5 GARLAND LN
GREENVILLE NY
12083-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-966-8612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: