Provider Demographics
NPI:1447050604
Name:VERNON, DAVID P (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:VERNON
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W AMERICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3123
Mailing Address - Country:US
Mailing Address - Phone:806-686-0881
Mailing Address - Fax:
Practice Address - Street 1:1411 WEST AMERICAN BLVD.
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347
Practice Address - Country:US
Practice Address - Phone:806-686-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist