Provider Demographics
NPI:1346526415
Name:DACUS, PAUL DAVID (PHARM D)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:DACUS
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 1:802 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2611
Mailing Address - Country:US
Mailing Address - Phone:423-836-1815
Mailing Address - Fax:
Practice Address - Street 1:802 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2611
Practice Address - Country:US
Practice Address - Phone:423-836-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist