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NPI Code Detail

MEDICARE: MARY GWEN DAMRON R.PH.

MEDICARE: MARY GWEN DAMRON R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist28868TX

General Provider Information

NPI Number : 1265727911
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY GWEN DAMRON R.PH.
Provider Business Mailing Address
First Line : 5959 LONG PRAIRIE RD
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-2224
Country : US
Telephone Number : 972-874-6709
Fax Number :
Provider Business Practice Location Address
First Line : 5959 LONG PRAIRIE RD
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-2224
Country : US
Telephone Number : 972-874-6709
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2011
Last Update Date : 06/10/2011

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Directions to “ MARY GWEN DAMRON R.PH.” Practice Location

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