Provider Demographics
NPI:1740567536
Name:POOL, DUSTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:POOL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 E 42ND ST
Mailing Address - Street 2:T-1506
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5939
Mailing Address - Country:US
Mailing Address - Phone:432-366-1913
Mailing Address - Fax:432-399-1913
Practice Address - Street 1:3909 E 42ND ST
Practice Address - Street 2:T-1506
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5939
Practice Address - Country:US
Practice Address - Phone:432-366-1913
Practice Address - Fax:432-399-1913
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist