Provider Demographics
NPI:1033447370
Name:ARCHIBONG, DOROTHY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:ARCHIBONG
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 1:5202 TEXANA DR APT 514
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3777
Mailing Address - Country:US
Mailing Address - Phone:713-320-0418
Mailing Address - Fax:
Practice Address - Street 1:8202 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1686
Practice Address - Country:US
Practice Address - Phone:210-543-8419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist