Provider Demographics
NPI:1902400229
Name:EXLINE, DAWN MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:EXLINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 US HIGHWAY 96 N
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-7298
Mailing Address - Country:US
Mailing Address - Phone:409-385-1441
Mailing Address - Fax:
Practice Address - Street 1:1100 US HIGHWAY 96 N
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-7298
Practice Address - Country:US
Practice Address - Phone:409-385-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist