Provider Demographics
NPI:1902180599
Name:DUNGAN, WESTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:WESTON
Middle Name:
Last Name:DUNGAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MEDPARK SQUARE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1708
Mailing Address - Country:US
Mailing Address - Phone:606-676-0199
Mailing Address - Fax:606-451-7727
Practice Address - Street 1:25 MEDPARK SQUARE DR STE 4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1708
Practice Address - Country:US
Practice Address - Phone:606-676-0199
Practice Address - Fax:606-457-7727
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist