MEDICARE: DANA DEWITT PHARMD

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	79180	CA

General Provider Information

NPI Number	:	1366910796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA DEWITT PHARMD

Provider Business Mailing Address
First Line	:	6008 VENTURA CANYON AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-3028
Country	:	US
Telephone Number	:	818-404-2457
Fax Number	:

Provider Business Practice Location Address
First Line	:	8844 LIMONITE AVE
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	92509-5021
Country	:	US
Telephone Number	:	951-968-7218
Fax Number	:

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

Provider Enumeration Date	:	11/03/2018
Last Update Date	:	06/29/2022

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