MEDICARE: MRS. KAUANA DANIELS-STILLS 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	021115	GA
2	183500000X	Pharmacist	37455	TX

General Provider Information

NPI Number	:	1790830594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAUANA DANIELS-STILLS RPH

Provider Business Mailing Address
First Line	:	377 LINGO PORT DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-1600
Country	:	US
Telephone Number	:	678-583-6935
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 FERST DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30332-0001
Country	:	US
Telephone Number	:	404-894-1430
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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