Provider Demographics
NPI:1821128646
Name:EUSTON, DEBRA SEWALT (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SEWALT
Last Name:EUSTON
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 1:708 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-1926
Mailing Address - Country:US
Mailing Address - Phone:432-684-7949
Mailing Address - Fax:432-684-7949
Practice Address - Street 1:2021 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4203
Practice Address - Country:US
Practice Address - Phone:432-580-0509
Practice Address - Fax:432-580-0516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist