Provider Demographics
NPI:1164838603
Name:CUMPTON, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:CUMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 NE VANCOUVER PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6643
Mailing Address - Country:US
Mailing Address - Phone:360-253-4038
Mailing Address - Fax:360-253-4037
Practice Address - Street 1:7809 NE VANCOUVER PLAZA DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6643
Practice Address - Country:US
Practice Address - Phone:360-253-4038
Practice Address - Fax:360-253-4037
Is Sole Proprietor?:No
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist