Provider Demographics
NPI:1144435629
Name:DUGAN, ELEANOR DAWN
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:DAWN
Last Name:DUGAN
Suffix:
Gender:F
Credentials:
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 166
Mailing Address - Street 2:
Mailing Address - City:STOLLINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25646-0166
Mailing Address - Country:US
Mailing Address - Phone:304-752-7360
Mailing Address - Fax:
Practice Address - Street 1:37 US ROUTE 80
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:WV
Practice Address - Zip Code:25621
Practice Address - Country:US
Practice Address - Phone:304-664-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist