Provider Demographics
NPI:1790090892
Name:BRANCH, DAWN W
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:W
Last Name:BRANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26214 TURKEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BUSH
Mailing Address - State:LA
Mailing Address - Zip Code:70431-2341
Mailing Address - Country:US
Mailing Address - Phone:985-886-9015
Mailing Address - Fax:
Practice Address - Street 1:1203 BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3278
Practice Address - Country:US
Practice Address - Phone:985-893-7476
Practice Address - Fax:985-893-5688
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist