Provider Demographics
NPI:1114295235
Name:RABON, DANA (RPH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:RABON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9810
Mailing Address - Country:US
Mailing Address - Phone:252-331-2149
Mailing Address - Fax:252-331-1271
Practice Address - Street 1:1700 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4554
Practice Address - Country:US
Practice Address - Phone:252-331-1207
Practice Address - Fax:252-331-2237
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12675183500000X
NCA00001257310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility