Provider Demographics
NPI:1477821288
Name:DAWSON, TANIYAH NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:TANIYAH
Middle Name:NICOLE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S FRYERS CREEK CIR APT 704
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7581
Mailing Address - Country:US
Mailing Address - Phone:214-924-5049
Mailing Address - Fax:
Practice Address - Street 1:937 CANYON CREEK DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3293
Practice Address - Country:US
Practice Address - Phone:254-774-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510281835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist