MEDICARE: DANIEL LEE DUDA JR. PHARMD

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	022202	KY

General Provider Information

NPI Number	:	1023782372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LEE DUDA JR. PHARMD

Provider Business Mailing Address
First Line	:	975 MANHATTAN BLVD APT 3405
Second Line	:
City	:	DAYTON
State	:	KY
Zip	:	41074-7509
Country	:	US
Telephone Number	:	513-939-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 STETSON ST STE F
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-5000
Country	:	US
Telephone Number	:	513-878-3426
Fax Number	:	513-878-3428

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

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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