Provider Demographics
NPI:1902815772
Name:DUNLAP, PAGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:DUNLAP
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 1:3020 AZTEC DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5242
Mailing Address - Country:US
Mailing Address - Phone:205-862-7243
Mailing Address - Fax:
Practice Address - Street 1:1700 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5337
Practice Address - Country:US
Practice Address - Phone:256-734-7188
Practice Address - Fax:256-734-7138
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115530-7183500000X
AL12156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115530-7OtherPHARMACY STATE LICENSE
AL12156OtherPHARMACY STATE LICENSE