Provider Demographics
NPI:1851912356
Name:HARE, DEE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:ANN
Last Name:HARE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:ANN
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:200 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:TX
Mailing Address - Zip Code:79014-3018
Mailing Address - Country:US
Mailing Address - Phone:806-663-0356
Mailing Address - Fax:
Practice Address - Street 1:200 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:TX
Practice Address - Zip Code:79014-3018
Practice Address - Country:US
Practice Address - Phone:806-323-6171
Practice Address - Fax:806-323-6133
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist