Provider Demographics
NPI:1578165015
Name:DUNN, MILEATA
Entity Type:Individual
Prefix:
First Name:MILEATA
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 S STATE HIGHWAY 161
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7205
Mailing Address - Country:US
Mailing Address - Phone:469-805-6330
Mailing Address - Fax:469-805-6329
Practice Address - Street 1:2650 S STATE HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7205
Practice Address - Country:US
Practice Address - Phone:469-805-6330
Practice Address - Fax:469-805-6329
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist