Provider Demographics
NPI:1063820561
Name:DAWLEY, KURTIS DAVID (PHARM-D)
Entity Type:Individual
Prefix:MR
First Name:KURTIS
Middle Name:DAVID
Last Name:DAWLEY
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MITCHELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3110
Mailing Address - Country:US
Mailing Address - Phone:301-352-3847
Mailing Address - Fax:
Practice Address - Street 1:4600 MITCHELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3110
Practice Address - Country:US
Practice Address - Phone:301-352-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist