Healthcare Provider Details

I. General information

NPI: 1568960219
Provider Name (Legal Business Name): DAN M DEWITYA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

IV. Provider business mailing address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4000
  • Fax: 919-956-4547
Mailing address:
  • Phone: 919-956-4000
  • Fax: 919-956-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: