Provider Demographics
NPI:1104282904
Name:DAWSON, DEMETRICA MARIE (RPH)
Entity type:Individual
Prefix:MS
First Name:DEMETRICA
Middle Name:MARIE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 BRYMOOR CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4830
Mailing Address - Country:US
Mailing Address - Phone:713-906-0114
Mailing Address - Fax:
Practice Address - Street 1:12863 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4807
Practice Address - Country:US
Practice Address - Phone:281-484-7100
Practice Address - Fax:281-484-2600
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist