Healthcare Provider Details

I. General information

NPI: 1245142769
Provider Name (Legal Business Name): MICHAEL DUNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 W DAVIS ST
CONROE TX
77304-1837
US

IV. Provider business mailing address

15411 MASSEY FOREST RD
NEW CANEY TX
77357-3473
US

V. Phone/Fax

Practice location:
  • Phone: 936-760-6810
  • Fax:
Mailing address:
  • Phone: 936-760-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number306151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: