Provider Demographics
NPI:1124331947
Name:DABNEY, JACKIE GLENN SR
Entity type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:GLENN
Last Name:DABNEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29203 LAKE COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-4643
Mailing Address - Country:US
Mailing Address - Phone:281-358-7485
Mailing Address - Fax:
Practice Address - Street 1:7440 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3129
Practice Address - Country:US
Practice Address - Phone:281-852-8088
Practice Address - Fax:281-812-0701
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX036524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist