Provider Demographics
NPI:1588138978
Name:DUNNAM, WILLIE NATHANAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:NATHANAEL
Last Name:DUNNAM
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GENERAL CANBY DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3036
Mailing Address - Country:US
Mailing Address - Phone:601-508-5036
Mailing Address - Fax:
Practice Address - Street 1:8985 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5311
Practice Address - Country:US
Practice Address - Phone:251-645-7979
Practice Address - Fax:251-645-9008
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist