=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942500632
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL EDWARD AVERY PHARM-D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2010
-----------------------------------------------------
Last Update Date | 10/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3450 W BELL RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85053-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-789-9643
-----------------------------------------------------
Fax | 602-866-9134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27512 N 58TH LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85083-7384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-320-6161
-----------------------------------------------------
Fax | 602-866-9134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16899
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------