Provider Demographics
NPI:1336755958
Name:DERMA DASH SERVICES, LLC
Entity Type:Organization
Organization Name:DERMA DASH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCHANS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-278-5986
Mailing Address - Street 1:4742 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3749
Mailing Address - Country:US
Mailing Address - Phone:210-278-5986
Mailing Address - Fax:210-634-2480
Practice Address - Street 1:4742 DODGE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3749
Practice Address - Country:US
Practice Address - Phone:210-278-5986
Practice Address - Fax:210-634-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy