Healthcare Provider Details

I. General information

NPI: 1821299439
Provider Name (Legal Business Name): DANIEL M TASSONE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 N DAVIDSON ST APT 251
CHARLOTTE NC
28205-1078
US

IV. Provider business mailing address

2901 N DAVIDSON ST APT #251
CHARLOTTE NC
28205-1078
US

V. Phone/Fax

Practice location:
  • Phone: 704-516-6229
  • Fax:
Mailing address:
  • Phone: 704-516-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number18007
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0202206658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: