MEDICARE: DAWN PHARMACY

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
1	305S00000X	Point of Service	26851	TX

General Provider Information

NPI Number	:	1558682690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN PHARMACY

Provider Business Mailing Address
First Line	:	12611 WOODFOREST BLVD STE P
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3457
Country	:	US
Telephone Number	:	713-455-0066
Fax Number	:	713-455-0119

Provider Business Practice Location Address
First Line	:	12611 WOODFOREST BLVD STE P
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3457
Country	:	US
Telephone Number	:	713-455-0066
Fax Number	:	713-455-0119

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANCIS CHIDI ANYANWU
Credential	:
Telephone Number	:	713-455-0066

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	06/11/2010

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