Provider Demographics
NPI:1841874617
Name:ROSS, DAWN LASHAY (CPHT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:LASHAY
Last Name:ROSS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAGWELL
Mailing Address - State:TX
Mailing Address - Zip Code:75412-0008
Mailing Address - Country:US
Mailing Address - Phone:903-715-1619
Mailing Address - Fax:
Practice Address - Street 1:3855 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5210
Practice Address - Country:US
Practice Address - Phone:903-785-8734
Practice Address - Fax:903-784-0256
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240904183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician