MEDICARE: MR. DANIEL LEE REDDEN 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	PS13110	FL

General Provider Information

NPI Number	:	1356370753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL LEE REDDEN RPH

Provider Business Mailing Address
First Line	:	1833 PELICAN CT
Second Line	:
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-1519
Country	:	US
Telephone Number	:	904-241-0116
Fax Number	:	904-241-9341

Provider Business Practice Location Address
First Line	:	4266 SUNBEAM RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6030
Country	:	US
Telephone Number	:	904-886-3883
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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