=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770874133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL KIM LAVIGNE PHARM.D., M.B.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2011
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 SUTTER PL
-----------------------------------------------------
City | DAVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95616-6201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-757-5147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2017
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-8017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-579-4802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 65300
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------