Provider Demographics
NPI:1124612429
Name:SONNIER, DWIGHT JEREMIAH
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:JEREMIAH
Last Name:SONNIER
Suffix:
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 1:13011 WINCREST CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2094
Mailing Address - Country:US
Mailing Address - Phone:317-774-6402
Mailing Address - Fax:
Practice Address - Street 1:14100 SPRING CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6286
Practice Address - Country:US
Practice Address - Phone:281-376-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist