Provider Demographics
NPI:1659667350
Name:DENNIS, RICHARD GARRETT (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GARRETT
Last Name:DENNIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 N. HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3707
Mailing Address - Country:US
Mailing Address - Phone:214-370-5558
Mailing Address - Fax:214-370-5558
Practice Address - Street 1:2403 N. HASKELL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3707
Practice Address - Country:US
Practice Address - Phone:214-370-5558
Practice Address - Fax:214-370-5558
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41533183500000X
OK8782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist