Healthcare Provider Details

I. General information

NPI: 1134255318
Provider Name (Legal Business Name): DANA W THORNTON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 BRUNSWICK RD
MEMPHIS TN
38133-4105
US

IV. Provider business mailing address

2911 BRUNSWICK RD
MEMPHIS TN
38133-4105
US

V. Phone/Fax

Practice location:
  • Phone: 901-377-4724
  • Fax:
Mailing address:
  • Phone: 901-377-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11050
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09289
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9933
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08931
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9530
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16212
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: