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General NPI Number Information
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NPI Number | 1811199094
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Entity Type | Individual
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Provider Name | DAISEN JOSE RPH
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 6516 LANDOVER RD
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City | CHEVERLY
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State | MD
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Zip | 20785-1445
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Country | US
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Telephone | 301-773-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 NILES DR
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City | LAUREL
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State | MD
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Zip | 20707-3233
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Country | US
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Telephone | 240-543-2517
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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 | 18039
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License Number State | MD
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