Provider Demographics
NPI:1689267791
Name:WILLIS, DAWNIA RICHARD (RPH)
Entity Type:Individual
Prefix:DR
First Name:DAWNIA
Middle Name:RICHARD
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5279
Mailing Address - Country:US
Mailing Address - Phone:337-942-1400
Mailing Address - Fax:337-942-5595
Practice Address - Street 1:507 N MARKET ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5279
Practice Address - Country:US
Practice Address - Phone:337-942-1400
Practice Address - Fax:337-942-5595
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2207482Medicaid