Provider Demographics
NPI:1104829266
Name:DAWSON, J. WESLEY (RPH, CCP)
Entity Type:Individual
Prefix:MR
First Name:J.
Middle Name:WESLEY
Last Name:DAWSON
Suffix:
Gender:M
Credentials:RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1513
Mailing Address - Country:US
Mailing Address - Phone:609-586-3063
Mailing Address - Fax:609-890-0805
Practice Address - Street 1:15 CORAL DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1513
Practice Address - Country:US
Practice Address - Phone:609-586-3063
Practice Address - Fax:609-890-0805
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI11557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist