Basic Information
Provider Information
NPI: 1003143082
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABSHIRE
FirstName: DUSTIN
MiddleName: MARSHALL
NamePrefix: MR.
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19639 EASTEX FWY
Address2:  
City: HUMBLE
State: TX
PostalCode: 773383500
CountryCode: US
TelephoneNumber: 2814461006
FaxNumber:  
Practice Location
Address1: 19639 EASTEX FWY
Address2:  
City: HUMBLE
State: TX
PostalCode: 773383500
CountryCode: US
TelephoneNumber: 2814461006
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/11/2009
LastUpdateDate: 11/11/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X46487TXY Pharmacy Service ProvidersPharmacist 

No ID Information.


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