=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417125857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALE B. THRESS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 02/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2778 N ROOSEVELT BLVD
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-294-0658
-----------------------------------------------------
Fax | 305-294-6378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2778 N ROOSEVELT BLVD
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-294-0658
-----------------------------------------------------
Fax | 305-294-6378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS0024689
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------