Healthcare Provider Details

I. General information

NPI: 1124612429
Provider Name (Legal Business Name): DWIGHT JEREMIAH SONNIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 09/10/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 SPRING CYPRESS RD
CYPRESS TX
77429-6286
US

IV. Provider business mailing address

13011 WINCREST CT
CYPRESS TX
77429-2094
US

V. Phone/Fax

Practice location:
  • Phone: 281-376-2428
  • Fax:
Mailing address:
  • Phone: 317-774-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: