Provider Demographics
NPI:1497731020
Name:DEDMON, DANNY B (DPH)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:B
Last Name:DEDMON
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 1:2353 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-5209
Mailing Address - Country:US
Mailing Address - Phone:731-285-0972
Mailing Address - Fax:731-285-8959
Practice Address - Street 1:101 S MILL AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-4636
Practice Address - Country:US
Practice Address - Phone:731-285-7284
Practice Address - Fax:731-285-8959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist