MEDICARE: MR. DANIEL B HELLER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP039848L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP039848L	OTHER	PA	PHARMACIST

General Provider Information

NPI Number	:	1275615031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL B HELLER RPH

Provider Business Mailing Address
First Line	:	255 S 17TH ST
Second Line	:	MEDICAL TOWER PHARMACY
City	:	PHILA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-3525
Fax Number	:	215-732-7013

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	MEDICAL TOWER PHARMACY
City	:	PHILA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-3525
Fax Number	:	215-732-7013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	10/06/2008

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