Healthcare Provider Details

I. General information

NPI: 1811158199
Provider Name (Legal Business Name): DWIGHT CLIFTON PAULSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N WASHINGTON AVE
DALLAS TX
75246-1754
US

IV. Provider business mailing address

16601 E CENTRETECH PKWY
AURORA CO
80011-9045
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-8202
  • Fax:
Mailing address:
  • Phone: 303-739-3564
  • Fax: 303-739-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15488
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: