Provider Demographics
NPI:1598046096
Name:EDNA GRACE DOWSON
Entity Type:Organization
Organization Name:EDNA GRACE DOWSON
Other - Org Name:SOUTHWEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-995-7912
Mailing Address - Street 1:9898 BISSONNET ST STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8033
Mailing Address - Country:US
Mailing Address - Phone:713-995-7912
Mailing Address - Fax:713-995-7918
Practice Address - Street 1:9898 BISSONNET ST STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8033
Practice Address - Country:US
Practice Address - Phone:713-995-7912
Practice Address - Fax:713-995-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX276053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5904948OtherNCPDP PROVIDER IDENTIFICATION NUMBER