Provider Demographics
NPI:1437311412
Name:EKLUM, DAWN RAE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RAE
Last Name:EKLUM
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 1:136 BEECHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-1660
Mailing Address - Country:US
Mailing Address - Phone:716-665-4922
Mailing Address - Fax:
Practice Address - Street 1:303 PINE ST
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138
Practice Address - Country:US
Practice Address - Phone:716-988-3410
Practice Address - Fax:716-988-3720
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist