MEDICARE: JOSEPH F DASTA 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	1835P1200X	Pharmacotherapy Pharmacist	03-1-10934	OH

General Provider Information

NPI Number	:	1538165857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH F DASTA RPH

Provider Business Mailing Address
First Line	:	2040 FINCASTLE CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2007
Country	:	US
Telephone Number	:	614-292-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W 12TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1214
Country	:	US
Telephone Number	:	614-292-6352
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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