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General NPI Number Information
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NPI Number | 1619040060
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Entity Type | Individual
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Provider Name | DANA BRUCE NELSON RPH
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HEALTHPLUS PHARMACY INC 948 A FOOTHILL BLVD
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-2701
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Country | US
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Telephone | 805-543-5966
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Fax | 805-543-3160
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Provider Business Mailing Address
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Address Line | 1234 VISTA DE LA MONTANA
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-4843
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Country | US
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Telephone | 805-543-3784
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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 | RPH27177
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License Number State | CA
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