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General NPI Number Information
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NPI Number | 1285917237
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Entity Type | Individual
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Provider Name | DANIEL ANTHONY BAUTISTA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 7479 LAKE WORTH RD
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City | LAKE WORTH
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State | FL
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Zip | 33467-2530
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Country | US
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Telephone | 561-965-4798
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Fax |
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Provider Business Mailing Address
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Address Line | 516 OSPREY DR 15B
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City | DELRAY BEACH
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State | FL
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Zip | 33444-2038
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Country | US
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Telephone | 954-512-7664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS47594
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License Number State | FL
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