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General NPI Number Information
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NPI Number | 1609133529
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Entity Type | Organization
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Legal Business Name | TEKISHA DUNMORE
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 15028 HIGHWAY 6
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City | ROSHARON
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State | TX
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Zip | 77583-3261
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Country | US
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Telephone | 281-710-4451
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Fax | 281-710-4452
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Provider Business Mailing Address
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Address Line | 15028 HIGHWAY 6
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City | ROSHARON
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State | TX
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Zip | 77583-3261
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Country | US
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Telephone | 281-710-4451
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Fax | 281-710-4452
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Authorized Official
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Title or Position | OWNER
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Name | TEKISHA ROSE
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Credential |
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Telephone | 281-710-4451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27912
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License Number State | TX
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