Provider Demographics
NPI:1538720263
Name:DUNAMIS PHARMACY, LLC
Entity type:Organization
Organization Name:DUNAMIS PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:IFEOMA
Authorized Official - Last Name:IGBOANUGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:480-310-0564
Mailing Address - Street 1:7030 BRETSHIRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-3704
Mailing Address - Country:US
Mailing Address - Phone:281-888-1409
Mailing Address - Fax:281-888-1393
Practice Address - Street 1:7030 BRETSHIRE DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-3704
Practice Address - Country:US
Practice Address - Phone:281-888-1409
Practice Address - Fax:281-888-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150139Medicaid