Provider Demographics
NPI:1215982558
Name:OWENS, DWIGHT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7170
Mailing Address - Country:US
Mailing Address - Phone:423-968-5061
Mailing Address - Fax:423-844-2866
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:DEPT OF PHARMACY
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-2868
Practice Address - Fax:423-844-2866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9371183500000X
NC12659183500000X
VA0202012710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist