Provider Demographics
NPI:1154417996
Name:DEW, DAVID CARL (RPH)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:DEW
Suffix:
Gender:M
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37769-0455
Mailing Address - Country:US
Mailing Address - Phone:865-426-6495
Mailing Address - Fax:865-426-9446
Practice Address - Street 1:414 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:TN
Practice Address - Zip Code:37769
Practice Address - Country:US
Practice Address - Phone:865-426-2851
Practice Address - Fax:865-426-9446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist