Provider Demographics
NPI:1366506685
Name:RUSH, DAWN NICHOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:NICHOLE
Last Name:RUSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:NC
Mailing Address - Zip Code:27844-0010
Mailing Address - Country:US
Mailing Address - Phone:252-586-5151
Mailing Address - Fax:252-586-6932
Practice Address - Street 1:204 EVANS ROAD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:NC
Practice Address - Zip Code:27844-0010
Practice Address - Country:US
Practice Address - Phone:252-586-5151
Practice Address - Fax:252-586-6932
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist