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Individual

DR. DAWN C FOUNTAIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
5062 S 155TH ST, OMAHA, NE 68137-5002
(402) 861-6966
(402) 861-6966
Mailing address
5801 S 167TH AVE, OMAHA, NE 68135-2397
(402) 740-8413

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9878
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9878
STATE ID
NE
Enumeration date
10/23/2011
Last updated
10/23/2011
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