Healthcare Provider Details

I. General information

NPI: 1154417996
Provider Name (Legal Business Name): DAVID CARL DEW R.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S. MAIN STREET
LAKE CITY TN
37769
US

IV. Provider business mailing address

PO BOX 455
LAKE CITY TN
37769-0455
US

V. Phone/Fax

Practice location:
  • Phone: 865-426-2851
  • Fax: 865-426-9446
Mailing address:
  • Phone: 865-426-6495
  • Fax: 865-426-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3792
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: