Provider Demographics
NPI:1679881999
Name:DAWSON, MATTHEW JEREMY (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JEREMY
Last Name:DAWSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3111
Mailing Address - Country:US
Mailing Address - Phone:318-442-5710
Mailing Address - Fax:318-442-4487
Practice Address - Street 1:604 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3111
Practice Address - Country:US
Practice Address - Phone:318-442-5710
Practice Address - Fax:318-442-4487
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist