Provider Demographics
NPI:1477864106
Name:DUNLAP, WILLIAM SHANNON (DPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SHANNON
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 OIL WELL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7929
Mailing Address - Country:US
Mailing Address - Phone:731-664-8892
Mailing Address - Fax:731-664-9195
Practice Address - Street 1:384 OIL WELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7929
Practice Address - Country:US
Practice Address - Phone:731-664-8892
Practice Address - Fax:731-664-9195
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist