Provider Demographics
NPI:1609133529
Name:TEKISHA DUNMORE
Entity Type:Organization
Organization Name:TEKISHA DUNMORE
Other - Org Name:SAVANNAH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-710-4451
Mailing Address - Street 1:15028 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3261
Mailing Address - Country:US
Mailing Address - Phone:281-710-4451
Mailing Address - Fax:281-710-4452
Practice Address - Street 1:15028 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3261
Practice Address - Country:US
Practice Address - Phone:281-710-4451
Practice Address - Fax:281-710-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905697OtherNCPDP PROVIDER IDENTIFICATION NUMBER