MEDICARE: MR. DANIEL D HINES 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	36448	CA

General Provider Information

NPI Number	:	1316247000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL D HINES RPH

Provider Business Mailing Address
First Line	:	33644 YUCAIPA BLVD
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-2071
Country	:	US
Telephone Number	:	909-790-1961
Fax Number	:	909-797-9526

Provider Business Practice Location Address
First Line	:	33644 YUCAIPA BLVD
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-2071
Country	:	US
Telephone Number	:	909-790-1961
Fax Number	:	909-797-9526

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

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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