MEDICARE: MR. DANIEL BREEZE GERSON CGP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP037408L	PA

General Provider Information

NPI Number	:	1023126224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL BREEZE GERSON CGP

Provider Business Mailing Address
First Line	:	3461 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4302
Country	:	US
Telephone Number	:	215-823-4509
Fax Number	:	215-823-4464

Provider Business Practice Location Address
First Line	:	3461 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4302
Country	:	US
Telephone Number	:	215-823-4509
Fax Number	:	215-823-4464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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