Healthcare Provider Details

I. General information

NPI: 1124690730
Provider Name (Legal Business Name): ROGER DANA HAUSMANN II PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANA HAUSMANN PHARMACY TECHNICIAN

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 EL CAMINO REAL
SANTA CLARA CA
95051-3041
US

IV. Provider business mailing address

2620 EL CAMINO REAL
SANTA CLARA CA
95051-3041
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-0919
  • Fax: 408-241-1202
Mailing address:
  • Phone: 408-241-0919
  • Fax: 408-241-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number159365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: