MEDICARE: CONNIE DAIDONE RPH

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	03213196	OH

General Provider Information

NPI Number	:	1063012391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE DAIDONE RPH

Provider Business Mailing Address
First Line	:	6955 MILLER LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2658
Country	:	US
Telephone Number	:	937-415-0198
Fax Number	:	937-415-1691

Provider Business Practice Location Address
First Line	:	6955 MILLER LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2658
Country	:	US
Telephone Number	:	937-415-0198
Fax Number	:	937-415-1691

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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Directions to “ CONNIE DAIDONE RPH” Practice Location

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