Provider Demographics
NPI:1861025025
Name:DEWALT, ZELDIA HOUSTON
Entity Type:Individual
Prefix:
First Name:ZELDIA
Middle Name:HOUSTON
Last Name:DEWALT
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 1:1107 SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-4405
Mailing Address - Country:US
Mailing Address - Phone:713-534-6665
Mailing Address - Fax:
Practice Address - Street 1:1107 SHAVER ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4405
Practice Address - Country:US
Practice Address - Phone:713-534-6665
Practice Address - Fax:713-534-6676
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25318OtherIMMUNIZATION AND POINT OF CARE TESTING
TX25318OtherPHARMACIST LICENSE